Provider Demographics
NPI:1578326252
Name:MERCADO, MAXI INEZ (PMHNP)
Entity Type:Individual
Prefix:
First Name:MAXI
Middle Name:INEZ
Last Name:MERCADO
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2903 W NEW HAVEN AVE # 591
Mailing Address - Street 2:
Mailing Address - City:W MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-3661
Mailing Address - Country:US
Mailing Address - Phone:321-872-8443
Mailing Address - Fax:
Practice Address - Street 1:2955 PINEDA PLAZA WAY STE 209
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7307
Practice Address - Country:US
Practice Address - Phone:321-610-4602
Practice Address - Fax:321-208-8119
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11030997363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health