Healthcare Provider Details

I. General information

NPI: 1063040418
Provider Name (Legal Business Name): JACQUELINE D MERCADO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E OSCEOLA PKWY STE 230
KISSIMMEE FL
34744-1616
US

IV. Provider business mailing address

1001 E OSCEOLA PKWY STE 230
KISSIMMEE FL
34744-1616
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-6060
  • Fax: 321-841-2442
Mailing address:
  • Phone: 321-841-6060
  • Fax: 321-841-2442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME182161
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: