Individual
MS. MELISSA MARIE CLINTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6901 SIMMONS LOOP, RIVERVIEW, FL 33578
(813) 302-8070
(813) 972-5055
Mailing address
2502 W ST. ISABEL ST., TAMPA, FL 33607
(813) 874-5707
(813) 972-5055
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA9104486
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
293023400
—
FL
01
—
P00865655
RAILROAD MEDICARE
FL
01
—
Y04EQ
BC/BS
FL
Enumeration date
01/22/2008
Last updated
11/04/2019
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