Healthcare Provider Details

I. General information

NPI: 1780818724
Provider Name (Legal Business Name): MELISSA LYN ABBOTT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3326 DEL PRADO BLVD S STE 8
CAPE CORAL FL
33904-7299
US

IV. Provider business mailing address

3434 HANCOCK BRIDGE PKWY STE 301
N FORT MYERS FL
33903-7094
US

V. Phone/Fax

Practice location:
  • Phone: 239-540-0081
  • Fax: 239-540-0023
Mailing address:
  • Phone: 877-856-3774
  • Fax: 239-599-2625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00216900
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9107122
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: