Provider Demographics
NPI:1366682155
Name:MERCED, NELSON JOEL
Entity Type:Individual
Prefix:MR
First Name:NELSON
Middle Name:JOEL
Last Name:MERCED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 HAMMERSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-6306
Mailing Address - Country:US
Mailing Address - Phone:863-353-1413
Mailing Address - Fax:
Practice Address - Street 1:3105 W WATERS AVE STE 212
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2873
Practice Address - Country:US
Practice Address - Phone:813-932-3013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLM623-630-83-296-0222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist