Provider Demographics
NPI:1619635703
Name:MERCADO, MELINDA (APRN)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:MERCADO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 WALMSLEY ST SW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32908-3353
Mailing Address - Country:US
Mailing Address - Phone:321-522-1124
Mailing Address - Fax:
Practice Address - Street 1:1810 ELDRON BLVD SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-6831
Practice Address - Country:US
Practice Address - Phone:321-434-3430
Practice Address - Fax:321-434-3432
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-06
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11010047363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily