Provider Demographics
NPI:1780338863
Name:CARRION, MELISSA MARIE (ARNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:CARRION
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 CHITTAMWOOD CT
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-0013
Mailing Address - Country:US
Mailing Address - Phone:407-739-7219
Mailing Address - Fax:
Practice Address - Street 1:719 RODEL CV
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-5716
Practice Address - Country:US
Practice Address - Phone:407-302-3115
Practice Address - Fax:321-203-4602
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11017983363LF0000X
FLAPRN11017983363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily