=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568943629
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANA LEIGH MELLO AGPCNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2018
-----------------------------------------------------
Last Update Date | 01/18/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 508 N ALEXANDER ST STE 1
-----------------------------------------------------
City | PLANT CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33563-3036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-759-6607
-----------------------------------------------------
Fax | 813-759-4670
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3001 EXECUTIVE DR STE 130
-----------------------------------------------------
City | CLEARWATER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33762-5323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-347-0005
-----------------------------------------------------
Fax | 727-541-6558
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | F308698-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | APRN11020931
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------