Provider Demographics
NPI:1811562960
Name:PHILLIPS, MERCEDES JACLYN (RN)
Entity Type:Individual
Prefix:MRS
First Name:MERCEDES
Middle Name:JACLYN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18002 RICHMOND PLACE DRIVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-1725
Mailing Address - Country:US
Mailing Address - Phone:813-442-3414
Mailing Address - Fax:
Practice Address - Street 1:18002 RICHMOND PLACE DRIVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-1725
Practice Address - Country:US
Practice Address - Phone:813-442-3414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9534454163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine