MEDICARE: MELISSA COOMBS RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	11042260	FL

General Provider Information

NPI Number	:	1902798259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA COOMBS RN

Provider Business Mailing Address
First Line	:	12780 WATERFORD LAKES PKWY STE 125
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-4502
Country	:	US
Telephone Number	:	407-384-1053
Fax Number	:	407-277-8168

Provider Business Practice Location Address
First Line	:	12780 WATERFORD LAKES PKWY STE 125
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-4502
Country	:	US
Telephone Number	:	407-384-1053
Fax Number	:	407-277-8168

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2025
Last Update Date	:	12/13/2025

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