Basic Information
| Provider Information | |||||||||
| NPI: | 1750631677 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MERRELL | ||||||||
| FirstName: | ELLEN | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5354 CYNTHIA STREET | ||||||||
| Address2: | |||||||||
| City: | MILTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504845040 | ||||||||
| FaxNumber: | 8504755507 | ||||||||
| Practice Location | |||||||||
| Address1: | 5192 BAYOU BLVD | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325032102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504845040 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2012 | ||||||||
| LastUpdateDate: | 09/18/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN9207953 | FL | Y | Nursing Service Providers | Registered Nurse |
No ID Information.