Provider Demographics
NPI:1588110266
Name:TAMAYO, MELISSA RACHEL
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:RACHEL
Last Name:TAMAYO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 SE 16TH AVE
Mailing Address - Street 2:APT F201
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-0546
Mailing Address - Country:US
Mailing Address - Phone:347-861-1910
Mailing Address - Fax:
Practice Address - Street 1:85 SE 16TH AVE
Practice Address - Street 2:APT F201
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-0546
Practice Address - Country:US
Practice Address - Phone:347-861-1910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant