Provider Demographics
NPI:1447608989
Name:MERCADO-REYES, YARITZA
Entity Type:Individual
Prefix:MS
First Name:YARITZA
Middle Name:
Last Name:MERCADO-REYES
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:N/A
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:1601 PINE MARSH LOOP
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-7409
Mailing Address - Country:US
Mailing Address - Phone:863-207-8377
Mailing Address - Fax:
Practice Address - Street 1:1601 PINE MARSH LOOP
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34771-7409
Practice Address - Country:US
Practice Address - Phone:863-207-8377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9202331363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily