Provider Demographics
NPI:1174692073
Name:MELLEN, DEBORAH JEAN DROZDIK (ARNP BC)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:JEAN DROZDIK
Last Name:MELLEN
Suffix:
Gender:F
Credentials:ARNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15021 SW 13TH COURT
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33326
Mailing Address - Country:US
Mailing Address - Phone:954-636-5984
Mailing Address - Fax:
Practice Address - Street 1:5901 COLONIAL DRIVE
Practice Address - Street 2:SUITE 303
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063
Practice Address - Country:US
Practice Address - Phone:954-984-8892
Practice Address - Fax:954-984-8810
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1274412363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU48742Medicaid