Provider Demographics
NPI:1528562030
Name:NOBLITT, MELISSA J (NP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:J
Last Name:NOBLITT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 CULTURAL PARK BLVD S # COTTAGE7
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-1229
Mailing Address - Country:US
Mailing Address - Phone:239-799-7299
Mailing Address - Fax:877-872-6441
Practice Address - Street 1:1020 CULTURAL PARK BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-1229
Practice Address - Country:US
Practice Address - Phone:239-799-7299
Practice Address - Fax:877-872-6441
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71007851A363LF0000X
FLAPRN11013385363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111882700Medicaid