Provider Demographics
NPI:1487638243
Name:MEIRING, MARYELLEN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MARYELLEN
Middle Name:
Last Name:MEIRING
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MARYELLEN
Other - Middle Name:
Other - Last Name:HANUSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:4351 CORTEZ RD W STE 200
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-3217
Mailing Address - Country:US
Mailing Address - Phone:941-345-1950
Mailing Address - Fax:941-345-1951
Practice Address - Street 1:4351 CORTEZ RD W STE 200
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3217
Practice Address - Country:US
Practice Address - Phone:941-345-1950
Practice Address - Fax:941-345-1951
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9227879363L00000X
FLARNP9227879363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003051800Medicaid
FLY04RAOtherBLUE CROSS BLUE SHIELD
FLU6446XMedicare PIN
FLY04RAOtherBLUE CROSS BLUE SHIELD