Healthcare Provider Details

I. General information

NPI: 1235763855
Provider Name (Legal Business Name): MELISSA SUE EININK AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2020
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CELEBRATION PL
CELEBRATION FL
34747-4970
US

IV. Provider business mailing address

400 CELEBRATION PL
CELEBRATION FL
34747-4970
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-7283
  • Fax:
Mailing address:
  • Phone: 407-303-7283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberAPRN11040264
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP.026368
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: