Provider Demographics
NPI:1376362905
Name:MOODY, MELANIE (ARNP-C)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:MOODY
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3055 NE 106TH ST
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:FL
Mailing Address - Zip Code:32617-3024
Mailing Address - Country:US
Mailing Address - Phone:509-771-1014
Mailing Address - Fax:
Practice Address - Street 1:1630 SE 18TH ST STE 202
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5441
Practice Address - Country:US
Practice Address - Phone:352-629-3311
Practice Address - Fax:352-629-4311
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11035772363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily