Healthcare Provider Details

I. General information

NPI: 1962058792
Provider Name (Legal Business Name): MELISSA ANN PHILLIPS MSPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 DR CARTER BLVD
BUNNELL FL
32110-6209
US

IV. Provider business mailing address

206 DR CARTER BLVD
BUNNELL FL
32110-6209
US

V. Phone/Fax

Practice location:
  • Phone: 386-313-7264
  • Fax: 386-437-8207
Mailing address:
  • Phone: 386-313-7264
  • Fax: 386-437-8207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: