Healthcare Provider Details

I. General information

NPI: 1306117007
Provider Name (Legal Business Name): MELISSA J. CEBALLOS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2012
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 S WILMOT RD
TUCSON AZ
85756-8699
US

IV. Provider business mailing address

98-1005 MOANALUA RD #400
AIEA HI
96701-4777
US

V. Phone/Fax

Practice location:
  • Phone: 520-574-0024
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-1618
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: