Provider Demographics
NPI:1225640113
Name:GARTH, MELISSA DIANE (APRN)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:DIANE
Last Name:GARTH
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 SE 63RD COURT RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34472-7885
Mailing Address - Country:US
Mailing Address - Phone:720-556-5732
Mailing Address - Fax:
Practice Address - Street 1:1395 SE 63RD COURT RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34472-7885
Practice Address - Country:US
Practice Address - Phone:720-556-5732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0995762-NP363LA2100X
FLAPRN11016355363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112820800Medicaid