Provider Demographics
NPI:1457632200
Name:MERRILL, NICOLE SCAIRONO (AUD)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:SCAIRONO
Last Name:MERRILL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15190 COMMUNITY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-3485
Mailing Address - Country:US
Mailing Address - Phone:228-539-3824
Mailing Address - Fax:228-539-1572
Practice Address - Street 1:15190 COMMUNITY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3485
Practice Address - Country:US
Practice Address - Phone:228-539-3824
Practice Address - Fax:228-539-1572
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA3606231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist