Provider Demographics
NPI:1912261710
Name:ROEBUCK-WATERS, MELISSA JOY (APRN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JOY
Last Name:ROEBUCK-WATERS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:JOY
Other - Last Name:ROEBUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:3449 SW STATE ROAD 26
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:FL
Mailing Address - Zip Code:32693-5641
Mailing Address - Country:US
Mailing Address - Phone:352-463-4895
Mailing Address - Fax:
Practice Address - Street 1:3449 SW STATE ROAD 26
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:FL
Practice Address - Zip Code:32693-5641
Practice Address - Country:US
Practice Address - Phone:352-463-4895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9226980363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health