Healthcare Provider Details

I. General information

NPI: 1235943317
Provider Name (Legal Business Name): MELISSA OGDEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 WATERMAN WAY
TAVARES FL
32778-5266
US

IV. Provider business mailing address

3606 HEATHERINGTON RD
ORLANDO FL
32808-2918
US

V. Phone/Fax

Practice location:
  • Phone: 407-491-4232
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11037527
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: