1114163144 NPI number — MELISSA L HOPPE PA-C

Table of content: MELISSA L HOPPE PA-C (NPI 1114163144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114163144 NPI number — MELISSA L HOPPE PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOPPE
Provider First Name:
MELISSA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114163144
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11724 SEWARD HWY
Provider Second Line Business Mailing Address:
STE D
Provider Business Mailing Address City Name:
SEWARD
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99664-9708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-224-8733
Provider Business Mailing Address Fax Number:
907-224-8734

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3021 W EAU GALLIE BLVD STE 103
Provider Second Line Business Practice Location Address:
SUITE 440
Provider Business Practice Location Address City Name:
MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32934-7005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-751-2707
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X , with the licence number:  PA9104802 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PA9104802 . This is a "LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com