Provider Demographics
NPI:1215420864
Name:MERKER, KHAYLA J (PA-C)
Entity type:Individual
Prefix:
First Name:KHAYLA
Middle Name:J
Last Name:MERKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KHAYLA
Other - Middle Name:N
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 1289
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33601-1289
Mailing Address - Country:US
Mailing Address - Phone:813-844-7000
Mailing Address - Fax:
Practice Address - Street 1:5 TAMPA GENERAL CIR STE 300
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3578
Practice Address - Country:US
Practice Address - Phone:813-251-0793
Practice Address - Fax:813-844-1988
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
FLPA9111424363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100454700Medicaid