Healthcare Provider Details

I. General information

NPI: 1184123622
Provider Name (Legal Business Name): BIANCA TRINIDAD MERCADO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2018
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 NW MYHRE RD
SILVERDALE WA
98383-7681
US

IV. Provider business mailing address

9621 RIDGETOP BLVD NW
SILVERDALE WA
98383-8502
US

V. Phone/Fax

Practice location:
  • Phone: 360-830-1301
  • Fax: 360-830-1305
Mailing address:
  • Phone: 360-830-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60838747
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: