Healthcare Provider Details

I. General information

NPI: 1366406183
Provider Name (Legal Business Name): NAZIM MERCHANT MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 07/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14015 EGRET TOWER DR
ORLANDO FL
32837-6197
US

IV. Provider business mailing address

14015 EGRET TOWER DR
ORLANDO FL
32837-6197
US

V. Phone/Fax

Practice location:
  • Phone: 407-447-7100
  • Fax: 407-447-6100
Mailing address:
  • Phone: 407-447-7100
  • Fax: 407-447-6100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME107095
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME119702
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP9419919
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME71136
License Number StateFL

VIII. Authorized Official

Name: SORAYA ROA
Title or Position: PRACTICE ADMINISTRATOR
Credential: RN
Phone: 407-447-7100