Provider Demographics
NPI:1194957068
Name:MERRILL, THERESA P (RN)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:P
Last Name:MERRILL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2658
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34230-2658
Mailing Address - Country:US
Mailing Address - Phone:941-861-3300
Mailing Address - Fax:941-861-2719
Practice Address - Street 1:7820 TAMIAMI TRL S STE B
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-5120
Practice Address - Country:US
Practice Address - Phone:941-861-3300
Practice Address - Fax:941-861-2719
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 9171853163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty