Provider Demographics
NPI:1053569905
Name:PRICE, MELISSA L (P A)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:PRICE
Suffix:
Gender:F
Credentials:P A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W GORE ST
Mailing Address - Street 2:STE 405
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1044
Mailing Address - Country:US
Mailing Address - Phone:407-425-8121
Mailing Address - Fax:407-425-8137
Practice Address - Street 1:100 W GORE ST
Practice Address - Street 2:STE 405
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1044
Practice Address - Country:US
Practice Address - Phone:407-425-8121
Practice Address - Fax:407-425-8137
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104021363AM0700X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical