Provider Demographics
NPI:1093157224
Name:VINCENT, ERICA BILES
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:BILES
Last Name:VINCENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 TURNER ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-7054
Mailing Address - Country:US
Mailing Address - Phone:910-246-2229
Mailing Address - Fax:910-246-0237
Practice Address - Street 1:135 TURNER ST
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-7054
Practice Address - Country:US
Practice Address - Phone:910-246-2229
Practice Address - Fax:910-246-0237
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC194896363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics