Basic Information
| Provider Information | |||||||||
| NPI: | 1194957068 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MERRILL | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | P. | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | R.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2658 | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342302658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9418613300 | ||||||||
| FaxNumber: | 9418612719 | ||||||||
| Practice Location | |||||||||
| Address1: | 7820 TAMIAMI TRL S STE B | ||||||||
| Address2: | |||||||||
| City: | VENICE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342935120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9418613300 | ||||||||
| FaxNumber: | 9418612719 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2009 | ||||||||
| LastUpdateDate: | 08/11/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC1500X | RN 9171853 | FL | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | Community Health |
No ID Information.