Healthcare Provider Details

I. General information

NPI: 1699446484
Provider Name (Legal Business Name): LYNETTE CANDELARIA MERCED APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 BUDINGER AVE STE 108
SAINT CLOUD FL
34769-4123
US

IV. Provider business mailing address

1330 BUDINGER AVE STE 108
SAINT CLOUD FL
34769-4123
US

V. Phone/Fax

Practice location:
  • Phone: 352-536-8644
  • Fax: 407-498-3402
Mailing address:
  • Phone: 352-536-8644
  • Fax: 407-498-3402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN11015529
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11015529
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11015529
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11015529
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: