Healthcare Provider Details

I. General information

NPI: 1285754119
Provider Name (Legal Business Name): MELANIE VIRGINIE MELLO ARNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELANIE VIRGINIE COTE MELLO ARNP-BC

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 05/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17201 CIVIC ST.
OKEECHOBEE FL
34974
US

IV. Provider business mailing address

20750 NW 176TH AVE
OKEECHOBEE FL
34972-3944
US

V. Phone/Fax

Practice location:
  • Phone: 863-763-0271
  • Fax:
Mailing address:
  • Phone: 863-763-4149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 3167812
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: