Healthcare Provider Details

I. General information

NPI: 1679246276
Provider Name (Legal Business Name): NAZIM MERCHANT MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 07/29/2021
Certification Date: 07/02/2021
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 TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: TONYA PRYCE
Title or Position: PRACTICE MANAGER
Credential:
Phone: 407-447-7100