Provider Demographics
NPI:1811494511
Name:CIVIL, MERLYNE
Entity type:Individual
Prefix:
First Name:MERLYNE
Middle Name:
Last Name:CIVIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7115 RUE GRANVILLE APT D
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33141-3589
Mailing Address - Country:US
Mailing Address - Phone:786-564-6392
Mailing Address - Fax:
Practice Address - Street 1:7115 RUE GRANVILLE APT D
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33141-3589
Practice Address - Country:US
Practice Address - Phone:786-564-6392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9291055363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care