Individual
DR. MELISSA NADINE BACCHUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2484 CARING WAY UNIT F, PORT CHARLOTTE, FL 33952-5306
(941) 625-1999
(941) 625-4600
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(941) 625-1999
(942) 625-4600
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME131001
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
021310300
—
FL
01
—
0RTMF
FLORIDA BLUE
FL
01
—
JA235Z
MEDICARE
FL
Enumeration date
08/08/2007
Last updated
07/22/2022
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