Healthcare Provider Details

I. General information

NPI: 1164918959
Provider Name (Legal Business Name): MERCEDES HEREDIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7951 SW 40TH ST STE 200
MIAMI FL
33155-6752
US

IV. Provider business mailing address

9800 SW 20TH ST
MIAMI FL
33165-7607
US

V. Phone/Fax

Practice location:
  • Phone: 305-876-6960
  • Fax: 305-876-6959
Mailing address:
  • Phone: 305-553-3364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number9416857
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9416857
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: