Provider Demographics
NPI:1215587647
Name:FERRARESI, NICOLINA (PA-C)
Entity Type:Individual
Prefix:
First Name:NICOLINA
Middle Name:
Last Name:FERRARESI
Suffix:
Gender:F
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 1:129 HAMMOCKS DR
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33413-2055
Mailing Address - Country:US
Mailing Address - Phone:410-980-5932
Mailing Address - Fax:
Practice Address - Street 1:5028 OKEECHOBEE BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-4534
Practice Address - Country:US
Practice Address - Phone:561-578-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9115540363AM0700X
PAMA061053363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical