Provider Demographics
NPI:1306738620
Name:TULLY, MELISSA JO (RN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:JO
Last Name:TULLY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9909 COLONNADE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-1861
Mailing Address - Country:US
Mailing Address - Phone:813-416-1641
Mailing Address - Fax:866-643-0569
Practice Address - Street 1:9909 COLONNADE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-1861
Practice Address - Country:US
Practice Address - Phone:813-416-1641
Practice Address - Fax:866-643-0569
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor