Individual
HEATHER MICHELLE MELLISH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2020 59TH ST W, BRADENTON, FL 34209-4604
(941) 792-6611
Mailing address
4630 HELENA ST NE, ST PETERSBURG, FL 33703-4358
(813) 951-0600
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
9336794
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023548600
—
FL
Enumeration date
01/03/2018
Last updated
01/08/2022
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