Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | ARNP9243906 | FL |
NPI | 1053822916 |
---|---|
Provider Name | Melissa Spies |
First Address | St Augustine, FL 32084-1867 |
Second Address | St Augustine, FL 32084-1867 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2017 |
Last Update Date | 10/11/2020 |