Provider Demographics
NPI:1992439897
Name:OUDKERK, MELANIE (FNP)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:OUDKERK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3841 SW WYCOFF ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-5302
Mailing Address - Country:US
Mailing Address - Phone:347-701-9684
Mailing Address - Fax:
Practice Address - Street 1:1072 LINCOLN PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-3525
Practice Address - Country:US
Practice Address - Phone:347-701-9684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-15
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY615055163WC0400X, 163WI0500X
FLAPRN11030966363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11030966Medicaid
FLRN9523800Medicaid