Provider Demographics
NPI:1457710287
Name:COLE, MELISSA G (ARNP, NP-C)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:G
Last Name:COLE
Suffix:
Gender:F
Credentials:ARNP, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6804 CECELIA DR
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-4935
Mailing Address - Country:US
Mailing Address - Phone:727-232-0644
Mailing Address - Fax:888-546-0488
Practice Address - Street 1:6804 CECELIA DR
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-4935
Practice Address - Country:US
Practice Address - Phone:727-232-0644
Practice Address - Fax:888-546-0488
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9359562363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017484200Medicaid
FLIP126YOtherMEDICARE PTAN