Provider Demographics
NPI:1477350064
Name:MERRIDA, NICOLE TRYNETTE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:TRYNETTE
Last Name:MERRIDA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 SPOTTED EAGLE ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-8587
Mailing Address - Country:US
Mailing Address - Phone:702-371-9064
Mailing Address - Fax:
Practice Address - Street 1:744 SPOTTED EAGLE ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-8587
Practice Address - Country:US
Practice Address - Phone:702-371-9064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCNA003346374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty