Provider Demographics
NPI:1316504996
Name:STALBIRD, MELANIE MARIE (APRN)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:MARIE
Last Name:STALBIRD
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 1:516 WIDEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-2338
Mailing Address - Country:US
Mailing Address - Phone:727-798-4712
Mailing Address - Fax:
Practice Address - Street 1:516 WIDEVIEW AVE
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-2338
Practice Address - Country:US
Practice Address - Phone:727-798-4712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11002424363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care