Provider Demographics
NPI:1306620992
Name:SHIVER, MELINDA W (APRN)
Entity type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:W
Last Name:SHIVER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5206 CREEKMORE LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-4027
Mailing Address - Country:US
Mailing Address - Phone:813-833-4867
Mailing Address - Fax:
Practice Address - Street 1:5206 CREEKMORE LN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-4027
Practice Address - Country:US
Practice Address - Phone:831-833-4867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11028093363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily