Provider Demographics
NPI:1740304427
Name:MERIDA, JANQUILYN DRIVER (DNP)
Entity type:Individual
Prefix:
First Name:JANQUILYN
Middle Name:DRIVER
Last Name:MERIDA
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:JANQUILYN
Other - Middle Name:I
Other - Last Name:DRIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 518
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75151-0518
Mailing Address - Country:US
Mailing Address - Phone:903-872-2151
Mailing Address - Fax:903-872-0126
Practice Address - Street 1:618 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-3028
Practice Address - Country:US
Practice Address - Phone:903-872-2151
Practice Address - Fax:903-872-0126
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0402043363LF0000X
TX654264363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDG9311OtherRAILROAD MEDICARE GROUP
TXP0046391OtherRAILROAD MEDICARE
TX00Y226OtherMEDICARE GROUP
TX005691305Medicaid
TX8F6257Medicare PIN
TX005691305Medicaid