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NPI Code Detail

MEDICARE: ERNST MERCERON

MEDICARE: ERNST MERCERON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner9310926FL
22085B0100XBody Imaging Physician73358FL
3363LF0000XFamily Nurse PractitionerAPRN11001311FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PG660OTHERFLHF MA

General Provider Information

NPI Number : 1194298851
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERNST MERCERON
Provider Business Mailing Address
First Line : 3300 S FISKE BLVD
Second Line :
City : ROCKLEDGE
State : FL
Zip : 32955-4306
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1810 ELDRON BLVD SE
Second Line :
City : PALM BAY
State : FL
Zip : 32909-6831
Country : US
Telephone Number : 321-312-3466
Fax Number : 321-409-6811
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2019
Last Update Date : 08/10/2022

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1558637686 — DR. GARY JOSEPH HARDOON M.D.
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1669213914 — KARLA NICOLE GONZALEZ APRN
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Directions to “ ERNST MERCERON ” Practice Location

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