Healthcare Provider Details

I. General information

NPI: 1457453409
Provider Name (Legal Business Name): NICOLE D MELENDEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE DIANE MELENDEZ

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4321 N MACDILL AVE
TAMPA FL
33607-6388
US

IV. Provider business mailing address

2995 DREW ST FL 3
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 813-356-7161
  • Fax: 813-840-3555
Mailing address:
  • Phone:
  • Fax: 727-266-4943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME103417
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2004016743
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD202522
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: