Provider Demographics
NPI:1376281576
Name:BRICENO, MARIA ANGELICA (NP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ANGELICA
Last Name:BRICENO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 JOHN CARLYLE ST APT 547
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-6860
Mailing Address - Country:US
Mailing Address - Phone:954-253-4390
Mailing Address - Fax:
Practice Address - Street 1:2946 SLEEPY HOLLOW RD STE B
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-2003
Practice Address - Country:US
Practice Address - Phone:703-417-9678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024184167363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care