Provider Demographics
NPI:1770888489
Name:NAIR, MELISSA WARNER (PA-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:WARNER
Last Name:NAIR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:A
Other - Last Name:WARNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2501 N ORANGE AVE STE 411
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4644
Mailing Address - Country:US
Mailing Address - Phone:407-303-1373
Mailing Address - Fax:407-303-0852
Practice Address - Street 1:2501 N ORANGE AVE STE 411
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4644
Practice Address - Country:US
Practice Address - Phone:407-303-1373
Practice Address - Fax:407-303-0852
Is Sole Proprietor?:No
Enumeration Date:2011-01-12
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105793363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003682400Medicaid
FLPA9105793OtherMEDICAL LICENSE
FLFH994ZMedicare PIN