Provider Demographics
NPI:1568436012
Name:PICA, JOSEPH J (PA)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:J
Last Name:PICA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 4TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-3802
Mailing Address - Country:US
Mailing Address - Phone:727-527-5272
Mailing Address - Fax:727-369-0305
Practice Address - Street 1:4600 4TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-3802
Practice Address - Country:US
Practice Address - Phone:727-527-5272
Practice Address - Fax:727-369-0305
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA1989363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291682700Medicaid
FLE4300ZMedicare ID - Type Unspecified