Provider Demographics
NPI:1255543849
Name:MERCADO, DIANA INIGUEZ (MD)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:INIGUEZ
Last Name:MERCADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 746638
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6638
Mailing Address - Country:US
Mailing Address - Phone:904-202-2092
Mailing Address - Fax:904-376-4705
Practice Address - Street 1:820 PRUDENTIAL DR STE 515
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8207
Practice Address - Country:US
Practice Address - Phone:904-396-4886
Practice Address - Fax:904-390-7487
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107426207RI0200X, 207R00000X
FLME 107426207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112309300Medicaid
FL1492COtherBCBS
GA003133154AMedicaid
FL002782600Medicaid