Healthcare Provider Details

I. General information

NPI: 1689505646
Provider Name (Legal Business Name): SHERLINE MERTILUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE FL 33136
MIAMI FL
33136-1005
US

IV. Provider business mailing address

16221 SW 18TH ST
MIRAMAR FL
33027-4457
US

V. Phone/Fax

Practice location:
  • Phone: 954-289-7722
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11047811
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: