Provider Demographics
NPI:1366857344
Name:SIEGEL, ERICA JOY (AP, LAC)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:JOY
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:AP, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7052 CYPRESS BRIDGE DR S
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-2513
Mailing Address - Country:US
Mailing Address - Phone:904-604-7608
Mailing Address - Fax:904-604-9890
Practice Address - Street 1:1106 A1A N STE 201A
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-4097
Practice Address - Country:US
Practice Address - Phone:904-604-7608
Practice Address - Fax:904-604-9890
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-27
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4339171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist