Provider Demographics
NPI:1740627967
Name:BAATZ, MELISSA LYNN (FNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNN
Last Name:BAATZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 DIPLOMA DR
Mailing Address - Street 2:
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-5326
Mailing Address - Country:US
Mailing Address - Phone:843-882-5031
Mailing Address - Fax:
Practice Address - Street 1:9625 HIGHWAY 78
Practice Address - Street 2:
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456-3913
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:401-652-1593
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18285363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP2412Medicaid
SCP01203036OtherRR-MEDICARE
SCP01203036OtherRR-MEDICARE