Provider Demographics
NPI:1215541784
Name:PICO, PATRICIA (MSN,APRN,NP-C)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:PICO
Suffix:
Gender:F
Credentials:MSN,APRN,NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16600 SW 52ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5188
Mailing Address - Country:US
Mailing Address - Phone:786-390-5046
Mailing Address - Fax:
Practice Address - Street 1:16600 SW 52ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-5188
Practice Address - Country:US
Practice Address - Phone:786-390-5046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11008854363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily