Healthcare Provider Details

I. General information

NPI: 1114841475
Provider Name (Legal Business Name): MELISSA BUSH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 S PARSONS AVE
BRANDON FL
33511-6063
US

IV. Provider business mailing address

811 S PARSONS AVE
BRANDON FL
33511-6063
US

V. Phone/Fax

Practice location:
  • Phone: 813-685-4553
  • Fax:
Mailing address:
  • Phone: 813-685-4553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number90108-049792010312
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: