Healthcare Provider Details

I. General information

NPI: 1710478201
Provider Name (Legal Business Name): MARIA THERESA MERCADO ESPIRITU APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4638 SUN N LAKE BLVD
SEBRING FL
33872
US

IV. Provider business mailing address

4638 SUN N LAKE BLVD
SEBRING FL
33872-2176
US

V. Phone/Fax

Practice location:
  • Phone: 863-386-0055
  • Fax: 863-386-0118
Mailing address:
  • Phone: 863-386-0055
  • Fax: 863-386-0118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9255125
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: