MEDICARE: MELISSA CHRISTINE SMITHDEAL RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	RN60122531	WA
2	363L00000X	Nurse Practitioner	APRN11031952	FL

General Provider Information

NPI Number	:	1134555022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA CHRISTINE SMITHDEAL RN

Provider Business Mailing Address
First Line	:	1543 MARBLE LAKE DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32221-5580
Country	:	US
Telephone Number	:	360-713-2440
Fax Number	:

Provider Business Practice Location Address
First Line	:	9680 ARGYLE FOREST BLVD STE 18
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32222-2847
Country	:	US
Telephone Number	:	360-713-2440
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2013
Last Update Date	:	04/24/2024

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