Healthcare Provider Details

I. General information

NPI: 1538746599
Provider Name (Legal Business Name): MERLANDIE ETIENNE HOUSTON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 03/25/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6072 DOCTORS PARK
MILTON FL
32570-5072
US

IV. Provider business mailing address

6002 BERRYHILL RD
MILTON FL
32570-5062
US

V. Phone/Fax

Practice location:
  • Phone: 850-983-4498
  • Fax:
Mailing address:
  • Phone: 850-626-7762
  • Fax: 850-626-5478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11011706
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: