Provider Demographics
NPI:1760982052
Name:MERCADO, PRISCILLA YVETTE (ARNP)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:YVETTE
Last Name:MERCADO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7201 WAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33896-6706
Mailing Address - Country:US
Mailing Address - Phone:407-948-5903
Mailing Address - Fax:
Practice Address - Street 1:1819 W OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4077
Practice Address - Country:US
Practice Address - Phone:407-948-5903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9304067363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care