Provider Demographics
NPI:1124131776
Name:RUDD, MELISSA L (PMHNP, APRN, DNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:RUDD
Suffix:
Gender:F
Credentials:PMHNP, APRN, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-7770
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3522 SADDLE BACK LN
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-4765
Practice Address - Country:US
Practice Address - Phone:813-974-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9350196363LF0000X
WAAP60919272363LF0000X, 363LP0808X
PASP009149363LP2300X
FLAPRN9350196363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1017131020001Medicaid
FL016684300Medicaid
FL113465700Medicaid
PA1898026OtherHIGHMARK
PA411445OtherUPMC
FLY0Q5EOtherBLUE CROSS BLUE SHIELD
PA1898026OtherHIGHMARK
FL016684300Medicaid