Provider Demographics
NPI:1215306964
Name:OLIVENCIA-LOZADA, MELINDA
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:OLIVENCIA-LOZADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8751 COMMODITY CIR
Mailing Address - Street 2:SUITE 10
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-9027
Mailing Address - Country:US
Mailing Address - Phone:407-345-5055
Mailing Address - Fax:
Practice Address - Street 1:1805 HOBBS RD
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:FL
Practice Address - Zip Code:33823-4644
Practice Address - Country:US
Practice Address - Phone:863-965-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-23
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9322861363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110601100Medicaid