Provider Demographics
NPI:1417949082
Name:SPENCE, PICCINA R (PA-C)
Entity Type:Individual
Prefix:MS
First Name:PICCINA
Middle Name:R
Last Name:SPENCE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:1061 HARMON AVE, SUITE 1D03
Mailing Address - Street 2:WINN ARMY COMMUNITY HOSPITAL
Mailing Address - City:FT. STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31315
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:192 LINDQUIST RD
Practice Address - Street 2:BLD 412, TFCMC
Practice Address - City:FT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-5122
Practice Address - Country:US
Practice Address - Phone:912-435-6633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2010-10-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA02958363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical