Healthcare Provider Details

I. General information

NPI: 1265828198
Provider Name (Legal Business Name): MELONNIE MARIE PRYOR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 BAY PINE BLVD
INDIAN ROCKS BEACH FL
33785-2838
US

IV. Provider business mailing address

10000 BAY PINES BLVD
BAY PINES FL
33744-8200
US

V. Phone/Fax

Practice location:
  • Phone: 727-504-9863
  • Fax:
Mailing address:
  • Phone: 727-398-6661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9302294
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: