Healthcare Provider Details

I. General information

NPI: 1326220062
Provider Name (Legal Business Name): MERCEDES FICARRA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11375 CORTEZ BLVD
BROOKSVILLE FL
34613-5409
US

IV. Provider business mailing address

PO BOX 741087
ATLANTA GA
30384-1087
US

V. Phone/Fax

Practice location:
  • Phone: 352-596-6632
  • Fax: 352-597-3095
Mailing address:
  • Phone: 352-596-6632
  • Fax: 352-597-3095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME114998
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD.201986
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: