Provider Demographics
NPI:1770026932
Name:MERCER, AMBER MICHELLE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:AMBER
Middle Name:MICHELLE
Last Name:MERCER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2735 PRINE RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-6751
Mailing Address - Country:US
Mailing Address - Phone:863-370-0086
Mailing Address - Fax:
Practice Address - Street 1:2735 PRINE RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-6751
Practice Address - Country:US
Practice Address - Phone:863-370-0086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5170072164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse