Provider Demographics
NPI:1275522062
Name:MERCADO, EDGARDO (PA)
Entity Type:Individual
Prefix:
First Name:EDGARDO
Middle Name:
Last Name:MERCADO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5534 GULF DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-4000
Mailing Address - Country:US
Mailing Address - Phone:727-847-1383
Mailing Address - Fax:727-848-1118
Practice Address - Street 1:5534 GULF DR
Practice Address - Street 2:SUITE 1
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4000
Practice Address - Country:US
Practice Address - Phone:727-847-3992
Practice Address - Fax:727-848-1118
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2453363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE0490CMedicare PIN
FLS53671Medicare UPIN