Provider Demographics
NPI:1033268677
Name:MCDONALD, MERLYN M (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MERLYN
Middle Name:M
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:MERLYN
Other - Middle Name:M
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-752-0944
Mailing Address - Fax:
Practice Address - Street 1:1130 HICKORY ST
Practice Address - Street 2:STE. B
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1973
Practice Address - Country:US
Practice Address - Phone:321-752-0944
Practice Address - Fax:321-434-7590
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9253571363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAA627ZWOtherMEDICARE
FL003250100Medicaid
FLP01833854OtherFL RR MEDICARE