Provider Demographics
NPI:1396364055
Name:MERCADO, ANASTASIA LEE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ANASTASIA
Middle Name:LEE
Last Name:MERCADO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:ANASTASIA
Other - Middle Name:JENNA
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:9089 S PECOS RD STE 3500
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7185
Mailing Address - Country:US
Mailing Address - Phone:702-550-7025
Mailing Address - Fax:
Practice Address - Street 1:9089 S PECOS RD STE 3500
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7185
Practice Address - Country:US
Practice Address - Phone:702-550-7025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV830020363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily