Provider Demographics
NPI:1861718835
Name:DURKIN, MELONIE
Entity type:Individual
Prefix:
First Name:MELONIE
Middle Name:
Last Name:DURKIN
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 1:2401 FRIST BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4839
Mailing Address - Country:US
Mailing Address - Phone:772-595-5302
Mailing Address - Fax:772-595-5304
Practice Address - Street 1:2401 FRIST BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4839
Practice Address - Country:US
Practice Address - Phone:772-595-5302
Practice Address - Fax:772-595-5304
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3127672363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily