Provider Demographics
NPI:1780618355
Name:WILSON, MELISA ANDREA (APRN)
Entity type:Individual
Prefix:MRS
First Name:MELISA
Middle Name:ANDREA
Last Name:WILSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2501 N ORANGE AVE STE 402
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4674
Mailing Address - Country:US
Mailing Address - Phone:407-303-3638
Mailing Address - Fax:407-303-2882
Practice Address - Street 1:2501 N ORANGE AVE STE 402
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4674
Practice Address - Country:US
Practice Address - Phone:407-303-3638
Practice Address - Fax:407-303-2882
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9212516363LA2100X
FLARNP9212516363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003841500Medicaid
FL003841500Medicaid