Healthcare Provider Details

I. General information

NPI: 1487605473
Provider Name (Legal Business Name): MELISSA A BORKOWSKI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA A FULLER ARNP

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 W NEWBERRY RD, EAST WING SUITE 100
GAINESVILLE FL
32605-4308
US

IV. Provider business mailing address

PO BOX 102222
ATLANTA GA
30368-2222
US

V. Phone/Fax

Practice location:
  • Phone: 352-332-3900
  • Fax: 352-332-5009
Mailing address:
  • Phone: 392-748-2002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number48698
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN2808682
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: