Provider Demographics
NPI:1467006080
Name:GODDARD, MELISSA ANN (NP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:GODDARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 TRINITY OAKS BLVD STE 216
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-4409
Mailing Address - Country:US
Mailing Address - Phone:727-372-2501
Mailing Address - Fax:813-635-2698
Practice Address - Street 1:2102 TRINITY OAKS BLVD STE 216
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-4409
Practice Address - Country:US
Practice Address - Phone:273-727-2501
Practice Address - Fax:813-635-2698
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11002777363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily