Provider Demographics
NPI:1205903952
Name:MERICLE, DEANNA LYNN (ARNP)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:LYNN
Last Name:MERICLE
Suffix:
Gender:F
Credentials:ARNP
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 6030
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32064-6030
Mailing Address - Country:US
Mailing Address - Phone:386-362-2708
Mailing Address - Fax:386-362-6301
Practice Address - Street 1:915 NOBLES FERRY RD
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-8463
Practice Address - Country:US
Practice Address - Phone:386-362-2708
Practice Address - Fax:386-362-6301
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1849412367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL301886500Medicaid
FL301886500Medicaid