Provider Demographics
NPI:1316466139
Name:VERTIN, MELINDA FIKE (NP)
Entity type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:FIKE
Last Name:VERTIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 GLENRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95136-1418
Mailing Address - Country:US
Mailing Address - Phone:408-267-7134
Mailing Address - Fax:
Practice Address - Street 1:970 GLENRIDGE DR.
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95136
Practice Address - Country:US
Practice Address - Phone:408-267-7134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA370212363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner