Healthcare Provider Details

I. General information

NPI: 1376362905
Provider Name (Legal Business Name): MELANIE MOODY ARNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 SE 18TH ST STE 202
OCALA FL
34471-5441
US

IV. Provider business mailing address

3055 NE 106TH ST
ANTHONY FL
32617-3024
US

V. Phone/Fax

Practice location:
  • Phone: 352-629-3311
  • Fax: 352-629-4311
Mailing address:
  • Phone: 509-771-1014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11035772
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: