Provider Demographics
NPI:1407511330
Name:MERCADO-HERNANDEZ, DAVID (RN)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MERCADO-HERNANDEZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8179 NW 8TH ST APT B4
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2887
Mailing Address - Country:US
Mailing Address - Phone:561-900-4177
Mailing Address - Fax:
Practice Address - Street 1:104 LEGION DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4804
Practice Address - Country:US
Practice Address - Phone:505-426-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-04
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9481783163W00000X
NM77734367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse