Provider Demographics
NPI:1851589030
Name:WALICEK, DEVAN C (ARNP)
Entity Type:Individual
Prefix:
First Name:DEVAN
Middle Name:C
Last Name:WALICEK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:4033 TAMPA RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-3224
Mailing Address - Country:US
Mailing Address - Phone:813-854-2003
Mailing Address - Fax:813-855-2367
Practice Address - Street 1:3222 W AZEELE ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3280
Practice Address - Country:US
Practice Address - Phone:813-872-8491
Practice Address - Fax:813-872-7766
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP 9252149363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics