Basic Information
| Provider Information | |||||||||
| NPI: | 1902314800 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MERCADO | ||||||||
| FirstName: | CASEY | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3885 OAKWATER CIR | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328066257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 0748165700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3885 OAKWATER CIR | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328066257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078165700 | ||||||||
| FaxNumber: | 4078126766 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2018 | ||||||||
| LastUpdateDate: | 04/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | 9303172 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | 363LA2200X | ARNP9303172 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 023689900 | 05 | FL | MEDICAID |