Provider Demographics
NPI:1083506398
Name:NELSON, MELISSA RENEE (APRN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:RENEE
Last Name:NELSON
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 1:21812 FIELD OF DREAMS LN
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33523-0632
Mailing Address - Country:US
Mailing Address - Phone:352-263-0624
Mailing Address - Fax:
Practice Address - Street 1:16244 REDSTONE WAY
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-4668
Practice Address - Country:US
Practice Address - Phone:813-430-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11040670363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily