Healthcare Provider Details

I. General information

NPI: 1568791069
Provider Name (Legal Business Name): THERESA M. MELOCHE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2009
Last Update Date: 11/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4142 MARINER BLVD #243
SPRING HILL FL
34609-0000
US

IV. Provider business mailing address

4142 MARINER BLVD #243
SPRING HILL FL
34609-0000
US

V. Phone/Fax

Practice location:
  • Phone: 800-561-4325
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9167432
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209007485
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP 3655
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209-007485
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: