Provider Demographics
NPI:1548736473
Name:MERCADO, TONYA RENAE (RN)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:RENAE
Last Name:MERCADO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:RENAE
Other - Last Name:TONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:205 S MAIN ST APT D
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-1251
Mailing Address - Country:US
Mailing Address - Phone:254-537-2662
Mailing Address - Fax:
Practice Address - Street 1:205 S MAIN ST APT D
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-1251
Practice Address - Country:US
Practice Address - Phone:254-537-2662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX907740163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse