Provider Demographics
NPI:1366991812
Name:CLEGG, MELISSA RENAE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:RENAE
Last Name:CLEGG
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:305 MEMORIAL MEDICAL PKWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5168
Mailing Address - Country:US
Mailing Address - Phone:386-671-0691
Mailing Address - Fax:386-671-0694
Practice Address - Street 1:305 MEMORIAL MEDICAL PKWY
Practice Address - Street 2:SUITE 301
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5168
Practice Address - Country:US
Practice Address - Phone:386-671-0691
Practice Address - Fax:386-671-0694
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP9190430363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health