Provider Demographics
NPI:1467507079
Name:MERCER, LYNDA MARIE (AUD)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:MARIE
Last Name:MERCER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:LYNDA
Other - Middle Name:MARIE
Other - Last Name:NALLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:7780 CAMBRIDGE MANOR PL STE C
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3656
Mailing Address - Country:US
Mailing Address - Phone:239-332-0707
Mailing Address - Fax:239-332-0780
Practice Address - Street 1:7780 CAMBRIDGE MANOR PL STE C
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3656
Practice Address - Country:US
Practice Address - Phone:239-332-0707
Practice Address - Fax:239-332-0780
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY000735231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL600230700Medicaid