Provider Demographics
NPI:1265234256
Name:MERCADO, KOANAKI (RN)
Entity type:Individual
Prefix:
First Name:KOANAKI
Middle Name:
Last Name:MERCADO
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:KOANAKI
Other - Middle Name:
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7720 N CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:CITRUS SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34434-6907
Mailing Address - Country:US
Mailing Address - Phone:727-858-1838
Mailing Address - Fax:727-858-1838
Practice Address - Street 1:4224 W GULF TO LAKE HWY
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-9215
Practice Address - Country:US
Practice Address - Phone:352-513-3482
Practice Address - Fax:352-513-3489
Is Sole Proprietor?:No
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9512859163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice