Provider Demographics
NPI:1124610290
Name:MERCADANTE, ANJELICA K (NP)
Entity type:Individual
Prefix:
First Name:ANJELICA
Middle Name:K
Last Name:MERCADANTE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 COMMERCE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-1186
Mailing Address - Country:US
Mailing Address - Phone:401-793-8484
Mailing Address - Fax:401-793-8481
Practice Address - Street 1:1 COMMERCE ST STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-1186
Practice Address - Country:US
Practice Address - Phone:401-793-8484
Practice Address - Fax:401-793-8481
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICAPRN03059363LF0000X
RIMM7170513363LF0000X
RIAPRN03059363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily