Provider Demographics
NPI:1457863755
Name:MERRICK, CARLA RENEE (APRNFNP-C)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:RENEE
Last Name:MERRICK
Suffix:
Gender:F
Credentials:APRNFNP-C
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:
Other - Last Name:GORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRNFNP-C
Mailing Address - Street 1:9500 EUCLID AVE STE A30
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6770 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2299
Practice Address - Country:US
Practice Address - Phone:440-449-4647
Practice Address - Fax:440-312-7112
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-26
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.021607363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily