Healthcare Provider Details

I. General information

NPI: 1770294340
Provider Name (Legal Business Name): MERCEDES JANE BRYCE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 NE 19TH DR
OKEECHOBEE FL
34972-1932
US

IV. Provider business mailing address

4200 COMMUNITY DR APT 1509
WEST PALM BEACH FL
33409-2750
US

V. Phone/Fax

Practice location:
  • Phone: 866-228-7676
  • Fax:
Mailing address:
  • Phone: 772-370-5676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11023032
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: