Provider Demographics
NPI:1588678601
Name:MERRILL, CAROL ANNE (ARNP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANNE
Last Name:MERRILL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:BAKERBELSCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:3831 TYRONE BLVD N STE 101
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-4114
Mailing Address - Country:US
Mailing Address - Phone:727-300-5100
Mailing Address - Fax:727-214-9333
Practice Address - Street 1:3831 TYRONE BLVD N STE 101
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-4114
Practice Address - Country:US
Practice Address - Phone:727-300-5100
Practice Address - Fax:727-214-9333
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1411722363LX0001X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE6475ZMedicare ID - Type Unspecified
FLE6475ZMedicare ID - Type Unspecified