Boudreaux, Melissa Beth

Boudreaux, Melissa Beth is an individual health care provider with primary practice located at 1040 River Heritage Blvd Suite 204, Bradenton FL 34212-6348. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Boudreaux, Melissa Beth can be contacted via phone (941) 917-7100.

Contact Information

Primary practice address
1040 River Heritage Blvd Suite 204 Bradenton FL 34212-6348
Phone: (941) 917-7100
Fax: (941) 917-7142
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA9102893 Florida

Profile Details

NPI number 1164490116
LBN Legal business name Boudreaux, Melissa Beth
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 8th, 2006
Last updated May 15th, 2018 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164490116 NPPES
Florida MEDICAID 291905200

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