MEDICARE: CHRISTY MERRITT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	ND7009	FL

General Provider Information

NPI Number	:	1194248799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTY MERRITT

Provider Business Mailing Address
First Line	:	1515 PAUL RUSSELL RD APT 16
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32301-6050
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1210 E PARK AVE
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32301-2653
Country	:	US
Telephone Number	:	850-765-6769
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2017
Last Update Date	:	07/25/2017

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