Provider Demographics
NPI:1851196711
Name:MELIDOR, MARISSA (APRN)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:MELIDOR
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 1:8130 LAKEWOOD MAIN ST STE 103
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5068
Mailing Address - Country:US
Mailing Address - Phone:941-499-2700
Mailing Address - Fax:941-487-0474
Practice Address - Street 1:8130 LAKEWOOD MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5068
Practice Address - Country:US
Practice Address - Phone:941-499-2700
Practice Address - Fax:941-487-0474
Is Sole Proprietor?:No
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11037710363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care