Healthcare Provider Details

I. General information

NPI: 1518670330
Provider Name (Legal Business Name): MELISSA BUZZI AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2022
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12825 NW 10TH LN
MIAMI FL
33182-1840
US

IV. Provider business mailing address

12825 NW 10TH LN
MIAMI FL
33182-1840
US

V. Phone/Fax

Practice location:
  • Phone: 305-308-2904
  • Fax:
Mailing address:
  • Phone: 305-308-2904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number11023449
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: