Provider Demographics
NPI:1679119986
Name:PARKER, CICELY NICOLE (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:CICELY
Middle Name:NICOLE
Last Name:PARKER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ZEUS CT
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-2470
Mailing Address - Country:US
Mailing Address - Phone:252-314-5784
Mailing Address - Fax:
Practice Address - Street 1:120 ZEUS CT
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-2470
Practice Address - Country:US
Practice Address - Phone:252-314-5784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11000739363LF0000X
FLAPRN11000739363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily