MEDICARE: MISS JADA MICHELLE MERRITT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679085195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JADA MICHELLE MERRITT

Provider Business Mailing Address
First Line	:	4836 S US HIGHWAY 1
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-7013
Country	:	US
Telephone Number	:	772-577-6783
Fax Number	:

Provider Business Practice Location Address
First Line	:	4836 S US HIGHWAY 1
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-7013
Country	:	US
Telephone Number	:	772-501-2123
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2017
Last Update Date	:	06/18/2020

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Directions to “ MISS JADA MICHELLE MERRITT ” Practice Location

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