Provider Demographics
NPI:1548440076
Name:MERRITT, GWENDOLYN ANN (ARNP)
Entity type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:ANN
Last Name:MERRITT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:GWENDOLYN
Other - Middle Name:
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 UNIVERSITY BLVD N
Mailing Address - Street 2:MC-75
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-9230
Mailing Address - Country:US
Mailing Address - Phone:904-253-2062
Mailing Address - Fax:904-253-1942
Practice Address - Street 1:120 KING ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-2410
Practice Address - Country:US
Practice Address - Phone:904-253-2785
Practice Address - Fax:904-253-1961
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2012872363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0062940-00Medicaid
FLAI332TMedicare Oscar/Certification
FLAI332TMedicare PIN
FLAI332ZMedicare PIN