Provider Demographics
NPI:1972390151
Name:BEAUFOY, MELISSA LYNN (FNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNN
Last Name:BEAUFOY
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2137 LOGGIA
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-9038
Mailing Address - Country:US
Mailing Address - Phone:323-977-9554
Mailing Address - Fax:
Practice Address - Street 1:2137 LOGGIA
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-9038
Practice Address - Country:US
Practice Address - Phone:323-977-9554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF03250734363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily