Provider Demographics
NPI:1154432466
Name:MCCLURE, MELODY ANN (ARNP, NP-C)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:ANN
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:ARNP, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 JOHN F KENNEDY DR
Mailing Address - Street 2:SUITE 134
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1141
Mailing Address - Country:US
Mailing Address - Phone:561-439-0308
Mailing Address - Fax:561-439-0371
Practice Address - Street 1:130 JFK DRIVE
Practice Address - Street 2:SUITE 134
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-0014
Practice Address - Country:US
Practice Address - Phone:561-439-0308
Practice Address - Fax:561-439-0371
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3010562363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAD127ZMedicare PIN