Healthcare Provider Details

I. General information

NPI: 1083691257
Provider Name (Legal Business Name): MERCEDES T PERNICE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 12/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4343 W NEWBERRY RD SUITE 1
GAINESVILLE FL
32607-2817
US

IV. Provider business mailing address

4881 NW 8TH AVE SUITE 2
GAINESVILLE FL
32605-4582
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-3502
  • Fax: 352-331-3488
Mailing address:
  • Phone: 352-373-6338
  • Fax: 352-373-6144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberME76081
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: