Healthcare Provider Details

I. General information

NPI: 1912870601
Provider Name (Legal Business Name): MELANIE ANDREA CHACON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 10/24/2025
Certification Date: 09/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 6TH AVE S
ST PETERSBURG FL
33701-4634
US

IV. Provider business mailing address

10601 GANDY BLVD N APT 6211
ST PETERSBURG FL
33702-1539
US

V. Phone/Fax

Practice location:
  • Phone: 727-898-7451
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN11041121
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: