Provider Demographics
NPI:1043652142
Name:MERCHANT, CARLA PATRICIA VIDAL (PA-C)
Entity Type:Individual
Prefix:
First Name:CARLA PATRICIA
Middle Name:VIDAL
Last Name:MERCHANT
Suffix:
Gender:F
Credentials: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:PO BOX 100277
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0277
Mailing Address - Country:US
Mailing Address - Phone:352-273-9079
Mailing Address - Fax:352-273-8889
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-2307
Practice Address - Country:US
Practice Address - Phone:352-273-9079
Practice Address - Fax:352-273-8889
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60630951363A00000X
FLPA9114592363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant