Healthcare Provider Details

I. General information

NPI: 1053393066
Provider Name (Legal Business Name): MELISSA GARRISON SMITH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA SUE GARRISON APRN

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7229 US HIGHWAY 301 S
RIVERVIEW FL
33578-4346
US

IV. Provider business mailing address

38135 MARKET SQ
ZEPHYRHILLS FL
33542-7505
US

V. Phone/Fax

Practice location:
  • Phone: 813-677-8418
  • Fax: 813-355-5906
Mailing address:
  • Phone: 352-567-0188
  • Fax: 813-355-5101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704194300
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9270004
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: