Basic Information
Provider Information | |||||||||
NPI: | 1225443765 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HAYSLIP | ||||||||
FirstName: | MELISSA | ||||||||
MiddleName: | LEIGH | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | ARNP, MSN | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HOFF | ||||||||
OtherFirstName: | MELISSA | ||||||||
OtherMiddleName: | LEIGH | ||||||||
OtherNamePrefix: | MISS | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 145 E POINSETT ST | ||||||||
Address2: |   | ||||||||
City: | GREER | ||||||||
State: | SC | ||||||||
PostalCode: | 296513405 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8642720388 | ||||||||
FaxNumber: | 5617987726 | ||||||||
Practice Location | |||||||||
Address1: | 3319 STATE ROAD 7 STE 109 | ||||||||
Address2: |   | ||||||||
City: | WELLINGTON | ||||||||
State: | FL | ||||||||
PostalCode: | 334498067 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5617985437 | ||||||||
FaxNumber: | 5617987726 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/23/2014 | ||||||||
LastUpdateDate: | 09/27/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/27/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | ARNP9268050 | FL | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.