Healthcare Provider Details

I. General information

NPI: 1710937461
Provider Name (Legal Business Name): MELISA TAIT N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 02/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 S HIGHWAY 29
CANTONMENT FL
32533-8699
US

IV. Provider business mailing address

2090 S HIGHWAY 29
CANTONMENT FL
32533-8699
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 866-389-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9202138
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: