Provider Demographics
NPI:1376115998
Name:MERRITT, DARA (APRN FNP-C)
Entity Type:Individual
Prefix:
First Name:DARA
Middle Name:
Last Name:MERRITT
Suffix:
Gender:F
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291C DUNN LN
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31788-1797
Mailing Address - Country:US
Mailing Address - Phone:229-921-7800
Mailing Address - Fax:
Practice Address - Street 1:2804 N OAK ST STE C
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-5913
Practice Address - Country:US
Practice Address - Phone:229-241-8925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN141655363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
RN141655OtherLICENSE
161455OtherLICENSE