Provider Demographics
NPI:1669751293
Name:MERCADO, ANGEL PETER (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:PETER
Last Name:MERCADO
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5155 CORPORATE WAY STE A
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-4359
Mailing Address - Country:US
Mailing Address - Phone:561-624-0123
Mailing Address - Fax:561-624-1453
Practice Address - Street 1:5155 CORPORATE WAY STE A
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458
Practice Address - Country:US
Practice Address - Phone:561-624-0123
Practice Address - Fax:561-624-1453
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY014992363A00000X
FLPA9114261363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty