=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376248443
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VIVIA MELISSA PARKINSON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2023
-----------------------------------------------------
Last Update Date | 01/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40124 HIGHWAY 27 STE 202
-----------------------------------------------------
City | DAVENPORT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33837-5905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-422-5331
-----------------------------------------------------
Fax | 863-422-5336
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11220 SW 238TH ST
-----------------------------------------------------
City | HOMESTEAD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33032-3103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-380-1062
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | 11025458
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 9293775
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------