Provider Demographics
NPI:1578219614
Name:MERCIER, MONIQUE LIZE (MAT, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:LIZE
Last Name:MERCIER
Suffix:
Gender:F
Credentials:MAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 GALE LEMERAND DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32611-2051
Mailing Address - Country:US
Mailing Address - Phone:541-880-8009
Mailing Address - Fax:
Practice Address - Street 1:121 GALE LEMERAND DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32611-7713
Practice Address - Country:US
Practice Address - Phone:541-880-8009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-28
Last Update Date:2024-01-04
Deactivation Date:2022-05-24
Deactivation Code:
Reactivation Date:2023-12-13
Provider Licenses
StateLicense IDTaxonomies
FLAL66532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer