Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | ARNP3223622 | FL |
NPI | 1235506270 |
---|---|
Provider Name | Mr. Daniel Mercado |
First Address | Orlando, FL 32806-2008 |
Second Address | Orlando, FL 32806-2008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2015 |
Last Update Date | 16/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
015586900 | (05) | FL |
ARNP3223622 | MEDICAL LICENSE (01) | FL |