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Individual

DR. MELISSA WAYBRANT-ENNIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APRN, DNP, PMHNP-BC

Contact information

Practice address
5964 US HIGHWAY 90, LIVE OAK, FL 32060-8694
(302) 981-8484
(833) 672-3395
Mailing address
5964 US HIGHWAY 90, LIVE OAK, FL 32060-8694
(302) 981-8484
(833) 672-3395

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
209015760
IL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
11003223
FL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
209015760
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
104165900
FL
01
11003223
APRN
FL
01
209015760
ADVANCED PRACTICE NURSE
IL
Enumeration date
04/14/2017
Last updated
05/13/2024
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