Provider Demographics
NPI:1104124064
Name:THOMAS, MELISSA S (APRN)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:S
Last Name:THOMAS
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:4205 BELFORT RD STE 4015
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:904-296-5691
Mailing Address - Fax:904-450-6401
Practice Address - Street 1:2 SHIRCLIFF WAY STE 435
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204
Practice Address - Country:US
Practice Address - Phone:904-308-6900
Practice Address - Fax:904-308-6927
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2019-12-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN3394912363L00000X
FLARNP3394912363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner