Provider Demographics
NPI:1679019095
Name:MEDEIROS, ERICA LYNN (DNP, AGPCNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:LYNN
Last Name:MEDEIROS
Suffix:
Gender:F
Credentials:DNP, AGPCNP-BC
Other - Prefix:MS
Other - First Name:ERICA
Other - Middle Name:LYNN
Other - Last Name:PINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 MILL RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:500 FAUNCE CORNER RD STE 170
Practice Address - Street 2:
Practice Address - City:NORTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-1277
Practice Address - Country:US
Practice Address - Phone:508-973-2216
Practice Address - Fax:508-973-1305
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-09
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2261320363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner