Provider Demographics
NPI:1992582316
Name:MELLEN, ANGELA DAWN (FNP-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:DAWN
Last Name:MELLEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 N CORY DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:FL
Mailing Address - Zip Code:32141-7226
Mailing Address - Country:US
Mailing Address - Phone:386-366-1780
Mailing Address - Fax:
Practice Address - Street 1:142 N CORY DR
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:FL
Practice Address - Zip Code:32141-7226
Practice Address - Country:US
Practice Address - Phone:386-366-1780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11028523363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily