Healthcare Provider Details

I. General information

NPI: 1609732999
Provider Name (Legal Business Name): MELODY CAMERON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4947 COVENANT CIR
PACE FL
32571-2545
US

IV. Provider business mailing address

4947 COVENANT CIR
PACE FL
32571-2545
US

V. Phone/Fax

Practice location:
  • Phone: 850-516-4877
  • Fax:
Mailing address:
  • Phone: 850-516-4877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9564570
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: