Healthcare Provider Details

I. General information

NPI: 1912374562
Provider Name (Legal Business Name): MISSY MELVIN NURSE ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2015
Last Update Date: 03/18/2022
Certification Date: 03/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 HICKORY LOOP WAY
OCALA FL
34472-4216
US

IV. Provider business mailing address

72 HICKORY LOOP WAY
OCALA FL
34472-4216
US

V. Phone/Fax

Practice location:
  • Phone: 352-361-3006
  • Fax:
Mailing address:
  • Phone: 352-361-3006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCNA362478
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: