Provider Demographics
NPI:1578671798
Name:WERES, MELANIE RIDGE (AACNP)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:RIDGE
Last Name:WERES
Suffix:
Gender:F
Credentials:AACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 W MONROE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-1177
Mailing Address - Country:US
Mailing Address - Phone:904-518-1398
Mailing Address - Fax:
Practice Address - Street 1:915 W MONROE ST STE 100
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-1177
Practice Address - Country:US
Practice Address - Phone:904-518-1398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903708363LA2100X
FL11033167363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS640507572PTOtherAMERICAN ADMIN GROUP
MS00125353Medicaid
P55563Medicare UPIN
500001024Medicare ID - Type Unspecified