Healthcare Provider Details

I. General information

NPI: 1922472901
Provider Name (Legal Business Name): MELISSA PEREZ CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2015
Last Update Date: 02/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 OAKFIELD DR
BRANDON FL
33511-5779
US

IV. Provider business mailing address

1901 ULMERTON RD SUITE 450
CLEARWATER FL
33762-2300
US

V. Phone/Fax

Practice location:
  • Phone: 813-571-5213
  • Fax:
Mailing address:
  • Phone: 727-210-8191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 9328549
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP 9328549
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: