Provider Demographics
NPI:1518224443
Name:SENIOR, MELISSA MARIE (ARNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:SENIOR
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:MARIE
Other - Last Name:OAKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP - PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3199
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:1155 E 21ST ST
Practice Address - Street 2:UFJP - ELIZABETH G. MEANS COMMUNITY HEALTH CENTER
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-2401
Practice Address - Country:US
Practice Address - Phone:904-633-0500
Practice Address - Fax:904-359-9623
Is Sole Proprietor?:No
Enumeration Date:2012-04-17
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9218049363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005612400Medicaid
FLGC700YMedicare PIN
FLP01161382Medicare PIN
FL005612400Medicaid