Healthcare Provider Details

I. General information

NPI: 1629540075
Provider Name (Legal Business Name): MELISSA COLEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2018
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1714 SW 17TH ST
OCALA FL
34471-1227
US

IV. Provider business mailing address

1714 SW 17TH ST
OCALA FL
34471-1227
US

V. Phone/Fax

Practice location:
  • Phone: 352-274-9900
  • Fax:
Mailing address:
  • Phone: 352-274-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11000716
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: