Provider Demographics
NPI:1801566278
Name:JUSINO, MELISSA
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:JUSINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3151 N ALAFAYA TRL STE 1101
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-2945
Mailing Address - Country:US
Mailing Address - Phone:407-207-5000
Mailing Address - Fax:407-207-8920
Practice Address - Street 1:3151 N ALAFAYA TRL STE 1101
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-2945
Practice Address - Country:US
Practice Address - Phone:407-207-5000
Practice Address - Fax:407-207-8920
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-16
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11015044363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner