Provider Demographics
NPI:1942638341
Name:LUTHER, MELINDA ANN (ARNP-C)
Entity type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:ANN
Last Name:LUTHER
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:ANN
Other - Last Name:VANDYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2614 JENKS AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4311
Mailing Address - Country:US
Mailing Address - Phone:850-215-3000
Mailing Address - Fax:850-215-3150
Practice Address - Street 1:2614 JENKS AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4311
Practice Address - Country:US
Practice Address - Phone:850-215-3000
Practice Address - Fax:850-215-3150
Is Sole Proprietor?:No
Enumeration Date:2013-10-22
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9368386207Q00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQTHNIOtherBLUE CROSS BLUE SHIELD
FL2120051OtherCIGNA