MEDICARE: DANA RENEE MERRITT FNP

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	363LF0000X	Family Nurse Practitioner	622607	TX

General Provider Information

NPI Number	:	1275810590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA RENEE MERRITT FNP

Provider Business Mailing Address
First Line	:	13450 N HWY 183
Second Line	:	SUITE 115
City	:	AUSTIN
State	:	TX
Zip	:	78750-3239
Country	:	US
Telephone Number	:	512-609-8338
Fax Number	:

Provider Business Practice Location Address
First Line	:	13450 N HWY 183
Second Line	:	SUITE 115
City	:	AUSTIN
State	:	TX
Zip	:	78750-3239
Country	:	US
Telephone Number	:	512-609-8338
Fax Number	:

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

Provider Enumeration Date	:	11/15/2011
Last Update Date	:	01/20/2012

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