Healthcare Provider Details

I. General information

NPI: 1538982657
Provider Name (Legal Business Name): MELISSA COFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30404 COLTHURST ST
WESLEY CHAPEL FL
33545-4244
US

IV. Provider business mailing address

30404 COLTHURST ST
WESLEY CHAPEL FL
33545-4244
US

V. Phone/Fax

Practice location:
  • Phone: 813-563-2019
  • Fax:
Mailing address:
  • Phone: 813-563-2019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: