Healthcare Provider Details

I. General information

NPI: 1083555619
Provider Name (Legal Business Name): MELISSA BLANCO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3470 W 110TH ST
HIALEAH GARDENS FL
33018-2179
US

IV. Provider business mailing address

3470 W 110TH ST
HIALEAH GARDENS FL
33018-2179
US

V. Phone/Fax

Practice location:
  • Phone: 305-299-3763
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF04260094
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: