Provider Demographics
NPI:1770684516
Name:PICKENS, JANET L (PA-C)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:L
Last Name:PICKENS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 APALACHEE PKWY
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-4542
Mailing Address - Country:US
Mailing Address - Phone:850-878-8843
Mailing Address - Fax:850-893-0019
Practice Address - Street 1:1160 APALACHEE PKWY
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-4542
Practice Address - Country:US
Practice Address - Phone:850-878-8843
Practice Address - Fax:850-893-0019
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 1705363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical