Provider Demographics
NPI:1912411711
Name:MERCILLIOTT, JANICE (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:MERCILLIOTT
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6707 STERLING RIDGE DR STE A
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-2773
Mailing Address - Country:US
Mailing Address - Phone:281-296-2656
Mailing Address - Fax:
Practice Address - Street 1:6707 STERLING RIDGE DR STE A
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-2773
Practice Address - Country:US
Practice Address - Phone:281-296-2656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-01
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135660363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics