Healthcare Provider Details

I. General information

NPI: 1376090456
Provider Name (Legal Business Name): MERRICK NURSE REGISTRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8461 LAKE WORTH RD STE 1-147
LAKE WORTH FL
33467-2474
US

IV. Provider business mailing address

8461 LAKE WORTH RD STE 1-147
LAKE WORTH FL
33467-2474
US

V. Phone/Fax

Practice location:
  • Phone: 561-713-1123
  • Fax:
Mailing address:
  • Phone: 561-713-1123
  • Fax: 561-713-1124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number30211870
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. PHYLLIS KHAN
Title or Position: PRESIDENT
Credential:
Phone: 561-713-1123