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General NPI Number Information
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NPI Number | 1528460185
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Entity Type | Individual
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Provider Name | MELISA DERVISEVIC FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/25/2014
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Last Update Date | 02/07/2023
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Provider Practice Location Address
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Address Line | 5880 RAND BLVD STE 211
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City | SARASOTA
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State | FL
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Zip | 34238-5118
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Country | US
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Telephone | 941-917-4753
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Fax | 941-917-4752
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Provider Business Mailing Address
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Address Line | 37 NEW HARTFORD SHOPPING CTR
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City | NEW HARTFORD
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State | NY
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Zip | 13413-2144
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Country | US
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Telephone | 315-735-2374
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Fax | 941-917-4752
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9338525
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 338806-1
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License Number State | NY
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