Provider Demographics
NPI:1659778322
Name:RICHARDSON, MELANIE APRIL (ARNP)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:APRIL
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3645 SPENCER LN
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8054
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2955 PINEDA PLAZA WAY
Practice Address - Street 2:SUITE 121
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7318
Practice Address - Country:US
Practice Address - Phone:814-241-1985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9386952363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily