Provider Demographics
NPI:1386102309
Name:MERLINE, ANN MORRIS BAILEY (PA)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:MORRIS BAILEY
Last Name:MERLINE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:MORRIS
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 CLARICE AVE APT 340
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2771
Mailing Address - Country:US
Mailing Address - Phone:205-789-7140
Mailing Address - Fax:
Practice Address - Street 1:1524 E MOREHEAD ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1606
Practice Address - Country:US
Practice Address - Phone:704-343-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-08770363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant