Healthcare Provider Details

I. General information

NPI: 1396262911
Provider Name (Legal Business Name): JENNIE LAUREL MERCHANT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 08/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 RIGGINS RD
TALLAHASSEE FL
32308-5317
US

IV. Provider business mailing address

PO BOX 13859
TALLAHASSEE FL
32317-3589
US

V. Phone/Fax

Practice location:
  • Phone: 850-877-4134
  • Fax:
Mailing address:
  • Phone: 850-877-4134
  • Fax: 850-402-9130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: