Provider Demographics
NPI:1841588548
Name:MINGO, ERICA NICOLE (D,O)
Entity Type:Individual
Prefix:MISS
First Name:ERICA
Middle Name:NICOLE
Last Name:MINGO
Suffix:
Gender:F
Credentials:D,O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FRANKLIN CORRECTION FACILITY
Mailing Address - Street 2:5918 NC-39
Mailing Address - City:BUNN
Mailing Address - State:NC
Mailing Address - Zip Code:27508
Mailing Address - Country:US
Mailing Address - Phone:919-496-6119
Mailing Address - Fax:
Practice Address - Street 1:620 JOHN PAUL JONES CIR
Practice Address - Street 2:GRADUATE MEDICAL EDUCATION
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708-2197
Practice Address - Country:US
Practice Address - Phone:757-953-0669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2020-03148208D00000X
NC03148208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice