Provider Demographics
NPI:1366406183
Name:NAZIM MERCHANT MD, PA
Entity type:Organization
Organization Name:NAZIM MERCHANT MD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SORAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:407-447-7100
Mailing Address - Street 1:14015 EGRET TOWER DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-6197
Mailing Address - Country:US
Mailing Address - Phone:407-447-7100
Mailing Address - Fax:407-447-6100
Practice Address - Street 1:14015 EGRET TOWER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-6197
Practice Address - Country:US
Practice Address - Phone:407-447-7100
Practice Address - Fax:407-447-6100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107095208000000X
FLME119702208000000X
FLARNP9419919363LP0200X
FLME71136208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263731600Medicaid