Provider Demographics
NPI:1336538057
Name:CHASEZ, MELISSA A (PA-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:CHASEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:A
Other - Last Name:BOWERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:2101 MYRTLEWOOD CIR E
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-6713
Mailing Address - Country:US
Mailing Address - Phone:407-690-1883
Mailing Address - Fax:
Practice Address - Street 1:2845 PGA BLVD
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2910
Practice Address - Country:US
Practice Address - Phone:561-693-0540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-19
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108506363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant