Provider Demographics
NPI:1063413649
Name:MERZENICH, ANGELA R (MD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:R
Last Name:MERZENICH
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4106 W LAKE MARY BLVD STE 225
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2403
Mailing Address - Country:US
Mailing Address - Phone:407-548-6530
Mailing Address - Fax:407-548-6535
Practice Address - Street 1:4106 W LAKE MARY BLVD STE 225
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2403
Practice Address - Country:US
Practice Address - Phone:407-548-6530
Practice Address - Fax:407-548-6535
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29075207Q00000X
FLME116431207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH04026Medicare UPIN