Provider Demographics
NPI:1104815455
Name:MEROLD, VICKI PAULINE (ARNP C)
Entity type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:PAULINE
Last Name:MEROLD
Suffix:
Gender:F
Credentials:ARNP C
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:PAULINE
Other - Last Name:GODWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1717 N E ST
Mailing Address - Street 2:STE 331
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-6335
Mailing Address - Country:US
Mailing Address - Phone:850-484-6500
Mailing Address - Fax:850-444-1755
Practice Address - Street 1:1717 N E ST
Practice Address - Street 2:STE 331
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-6335
Practice Address - Country:US
Practice Address - Phone:850-484-6500
Practice Address - Fax:850-857-1747
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1233422363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307108100Medicaid
FL1104815455OtherNPI
Q48300Medicare UPIN