MEDICARE: MS. MELISSA ANNE PATTERSON

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	251J00000X	Nursing Care Agency	CNA103063	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CNA103063	OTHER	FL	CERTIFIED NURSING ASSISTA

General Provider Information

NPI Number	:	1679646087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELISSA ANNE PATTERSON

Provider Business Mailing Address
First Line	:	22 RAINTREE DR
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-5937
Country	:	US
Telephone Number	:	386-295-0337
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 RAINTREE DR
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-5937
Country	:	US
Telephone Number	:	386-295-0337
Fax Number	:

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

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	06/12/2012

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