Provider Demographics
NPI:1003366592
Name:MERRITT, MELISSA WYNNE (MMS, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:WYNNE
Last Name:MERRITT
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32502-6046
Mailing Address - Country:US
Mailing Address - Phone:850-432-6772
Mailing Address - Fax:
Practice Address - Street 1:200 E GARDEN ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-6046
Practice Address - Country:US
Practice Address - Phone:850-432-6772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-07
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL363A00000X
FL9109994363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019352500Medicaid
FLIU339ZMedicare UPIN