Provider Demographics
NPI:1699010157
Name:MERRITT, MARCIE LEANN (NP)
Entity Type:Individual
Prefix:
First Name:MARCIE
Middle Name:LEANN
Last Name:MERRITT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1447
Mailing Address - Street 2:
Mailing Address - City:FITZGERALD
Mailing Address - State:GA
Mailing Address - Zip Code:31750-1447
Mailing Address - Country:US
Mailing Address - Phone:229-424-7273
Mailing Address - Fax:
Practice Address - Street 1:182 PERRY HOUSE RD
Practice Address - Street 2:SUITE D
Practice Address - City:FITZGERALD
Practice Address - State:GA
Practice Address - Zip Code:31750-8721
Practice Address - Country:US
Practice Address - Phone:229-424-7273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN176738363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily