Healthcare Provider Details

I. General information

NPI: 1487392197
Provider Name (Legal Business Name): MS. MERCEDES DESPAIGNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 PRIMERA BLVD STE 520
LAKE MARY FL
32746-2158
US

IV. Provider business mailing address

255 PRIMERA BLVD STE 520
LAKE MARY FL
32746-2158
US

V. Phone/Fax

Practice location:
  • Phone: 689-282-6774
  • Fax:
Mailing address:
  • Phone: 689-282-6774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number11018991
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11018991
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: