Provider Demographics
NPI:1750631677
Name:MERRELL, ELLEN ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:ANN
Last Name:MERRELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5354 CYNTHIA STREET
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32583
Mailing Address - Country:US
Mailing Address - Phone:850-484-5040
Mailing Address - Fax:850-475-5507
Practice Address - Street 1:5192 BAYOU BLVD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2102
Practice Address - Country:US
Practice Address - Phone:850-484-5040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9207953163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse