Provider Demographics
NPI:1114222056
Name:NICOTERA, PHILIP CHRISTOPHER (PA-C)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:CHRISTOPHER
Last Name:NICOTERA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2673 WESTCOTT CIR
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-1746
Mailing Address - Country:US
Mailing Address - Phone:850-445-8429
Mailing Address - Fax:
Practice Address - Street 1:2673 WESTCOTT CIR
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-1746
Practice Address - Country:US
Practice Address - Phone:850-445-8429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105548363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical