Provider Demographics
NPI:1336784735
Name:MERRILL, AMBER ROSE
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:ROSE
Last Name:MERRILL
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:MERRILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14382 N WILD BURRO CANYON PL
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85658-1420
Mailing Address - Country:US
Mailing Address - Phone:661-839-4738
Mailing Address - Fax:
Practice Address - Street 1:1625 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-4330
Practice Address - Country:US
Practice Address - Phone:520-694-0111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-10
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSTUDENT2086S0127X
AZRN182924363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery