Provider Demographics
NPI:1215921366
Name:AUTIERI, MELISSA R (ARNP-C)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:R
Last Name:AUTIERI
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 DRUID RD E
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756
Mailing Address - Country:US
Mailing Address - Phone:727-446-1097
Mailing Address - Fax:727-441-2195
Practice Address - Street 1:708 DRUID RD E.
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756
Practice Address - Country:US
Practice Address - Phone:727-446-1097
Practice Address - Fax:727-441-2195
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0062584207K00000X
FLARNP3301392363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304126300Medicaid
E6551 VMedicare ID - Type Unspecified
FL304126300Medicaid
P45108Medicare UPIN