MEDICARE: MR. JOSEPH ANTHONY MERTES JR. APRN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN11032563	FL

General Provider Information

NPI Number	:	1588412142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH ANTHONY MERTES JR. APRN

Provider Business Mailing Address
First Line	:	1220 JENKS AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-2441
Country	:	US
Telephone Number	:	850-640-1874
Fax Number	:	850-640-1875

Provider Business Practice Location Address
First Line	:	1220 JENKS AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-2441
Country	:	US
Telephone Number	:	850-640-1874
Fax Number	:	850-640-1875

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

Provider Enumeration Date	:	05/08/2024
Last Update Date	:	05/17/2024

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