Provider Demographics
NPI:1528046448
Name:MERRY, CHARLES WILLIAM (CRNA)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:WILLIAM
Last Name:MERRY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4839 PARKHURST PL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6046
Mailing Address - Country:US
Mailing Address - Phone:904-568-6698
Mailing Address - Fax:
Practice Address - Street 1:ST VINCENTS MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223
Practice Address - Country:US
Practice Address - Phone:904-568-6698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2750812367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL302678700Medicaid
GA00881669BMedicaid
FL62437OtherBLUE CROSS