Basic Information
| Provider Information | |||||||||
| NPI: | 1093780785 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MACHAN | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | D. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 452317 | ||||||||
| Address2: | |||||||||
| City: | SUNRISE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333452317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9548382588 | ||||||||
| FaxNumber: | 9545143960 | ||||||||
| Practice Location | |||||||||
| Address1: | 1613 N HARRISON PKWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SUNRISE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9548382588 | ||||||||
| FaxNumber: | 9545143960 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2006 | ||||||||
| LastUpdateDate: | 10/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | ARNP3362092 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 306201500 | 05 | FL | MEDICAID |