Provider Demographics
NPI:1285248310
Name:CHANG, MERREL (APRN)
Entity type:Individual
Prefix:
First Name:MERREL
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11203 REGATTA LN
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33449-7416
Mailing Address - Country:US
Mailing Address - Phone:954-849-5934
Mailing Address - Fax:
Practice Address - Street 1:1236 ROYAL PALM BEACH BLVD STE 108
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-1602
Practice Address - Country:US
Practice Address - Phone:561-774-8660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-05
Last Update Date:2020-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11009042208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11009042OtherFLORIDA DEPARTMENT OF HEALTH