MEDICARE: MELANIE CONCEPCION PEREZ APRN

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	363LF0000X	Family Nurse Practitioner	APRN11034139	FL

General Provider Information

NPI Number	:	1639904022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE CONCEPCION PEREZ APRN

Provider Business Mailing Address
First Line	:	PO BOX 748817
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-8817
Country	:	US
Telephone Number	:	813-286-0033
Fax Number	:	813-282-1806

Provider Business Practice Location Address
First Line	:	1232 KING ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4212
Country	:	US
Telephone Number	:	904-384-3699
Fax Number	:

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

Provider Enumeration Date	:	09/04/2024
Last Update Date	:	09/10/2024

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