Healthcare Provider Details

I. General information

NPI: 1619425808
Provider Name (Legal Business Name): MIREILLE MERISIER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MIREILLE JEAN-MARY ARNP

II. Dates (important events)

Enumeration Date: 09/15/2016
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5909 S UNIVERSITY DR
DAVIE FL
33328-6115
US

IV. Provider business mailing address

16238 NW 19TH ST
PEMBROKE PINES FL
33028-1743
US

V. Phone/Fax

Practice location:
  • Phone: 954-372-7955
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9326614
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberARNP9326614
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: