Provider Demographics
NPI:1740823723
Name:MERCHANT, AUNDREA SHALISE (APRN)
Entity type:Individual
Prefix:
First Name:AUNDREA
Middle Name:SHALISE
Last Name:MERCHANT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:AUNDREA
Other - Middle Name:
Other - Last Name:SPONSEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN, FNP-BC
Mailing Address - Street 1:PO BOX 958
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34688-0958
Mailing Address - Country:US
Mailing Address - Phone:727-487-7066
Mailing Address - Fax:
Practice Address - Street 1:111 CLOCK TOWER CMNS
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-4055
Practice Address - Country:US
Practice Address - Phone:845-279-5187
Practice Address - Fax:845-279-5168
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-23
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11004282363LP0808X, 363LF0000X
FL353980363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty