Healthcare Provider Details

I. General information

NPI: 1275057325
Provider Name (Legal Business Name): TRACEY MERRIMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TRACEY JUDD

II. Dates (important events)

Enumeration Date: 07/31/2017
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29000 CENTER RIDGE RD
WESTLAKE OH
44145-5219
US

IV. Provider business mailing address

5455 N MARGINAL RD APT 515
CLEVELAND OH
44114-3951
US

V. Phone/Fax

Practice location:
  • Phone: 440-827-5559
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN.CNP.021589
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberAPRN.CNP.021589
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: