Provider Demographics
NPI:1124507751
Name:CORDOVA, MELISSA ROSE (ARNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ROSE
Last Name:CORDOVA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ROSE
Other - Last Name:MARFAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1134 KYLE WOOD LN
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4850
Mailing Address - Country:US
Mailing Address - Phone:813-850-7434
Mailing Address - Fax:813-482-9794
Practice Address - Street 1:1134 KYLE WOOD LN
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4850
Practice Address - Country:US
Practice Address - Phone:813-850-7434
Practice Address - Fax:813-482-9794
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9325307363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily