MEDICARE: MRS. MELISSA MARIE HIRSH I ANP-BC

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	363LA2200X	Adult Health Nurse Practitioner	ARNP 9392019	FL

General Provider Information

NPI Number	:	1710376728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA MARIE HIRSH I ANP-BC

Provider Business Mailing Address
First Line	:	102 CIPRIANI CT
Second Line	:
City	:	NORTH VENICE
State	:	FL
Zip	:	34275-6688
Country	:	US
Telephone Number	:	941-929-8568
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 CIPRIANI CT
Second Line	:
City	:	NORTH VENICE
State	:	FL
Zip	:	34275-6688
Country	:	US
Telephone Number	:	941-929-8568
Fax Number	:

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

Provider Enumeration Date	:	01/14/2015
Last Update Date	:	01/14/2015

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