Provider Demographics
NPI:1881717387
Name:HAYES, MELANIE E (ARNP)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:E
Last Name:HAYES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:D
Other - Last Name:EZELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6028 BENNETT RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-5004
Mailing Address - Country:US
Mailing Address - Phone:904-737-6422
Mailing Address - Fax:904-730-8144
Practice Address - Street 1:6028 BENNETT RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-5004
Practice Address - Country:US
Practice Address - Phone:904-737-6422
Practice Address - Fax:904-730-8144
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2779462363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ51430Medicare UPIN