Provider Demographics
NPI:1750958138
Name:TITUS, MELISSA SUE (RN)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:SUE
Last Name:TITUS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3840 BELFORT RD STE 302
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8210
Mailing Address - Country:US
Mailing Address - Phone:904-503-3579
Mailing Address - Fax:
Practice Address - Street 1:3840 BELFORT RD STE 302
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8210
Practice Address - Country:US
Practice Address - Phone:904-503-3579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-05
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9315016163W00000X
FLAPRN11014942363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse