Provider Demographics
NPI:1285932707
Name:COFFMAN, MELINDA L (APN)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:L
Last Name:COFFMAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 49TH ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-2114
Mailing Address - Country:US
Mailing Address - Phone:727-521-5423
Mailing Address - Fax:
Practice Address - Street 1:6000 49TH ST N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-2114
Practice Address - Country:US
Practice Address - Phone:727-521-5423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARATP-000349363L00000X
FLARNP 9359717363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP 9359717OtherSTATE OF FL DEPARTMENT OF HEALTH DIVISI MEDICAL QUALITY ASSURANCE ARNP
ARA03530OtherARSBN