Healthcare Provider Details

I. General information

NPI: 1083506398
Provider Name (Legal Business Name): MELISSA RENEE NELSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14306 7TH ST
DADE CITY FL
33523-3434
US

IV. Provider business mailing address

1839 CENTRAL AVE
ST PETERSBURG FL
33713-9089
US

V. Phone/Fax

Practice location:
  • Phone: 813-640-0060
  • Fax: 813-779-7700
Mailing address:
  • Phone: 727-322-1054
  • Fax: 727-322-2725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11040670
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: