Provider Demographics
NPI:1255848610
Name:EASTER, ERICA (AP)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:EASTER
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6576
Mailing Address - Country:US
Mailing Address - Phone:407-796-1260
Mailing Address - Fax:
Practice Address - Street 1:1507 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6576
Practice Address - Country:US
Practice Address - Phone:407-796-1260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3523171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist