Provider Demographics
NPI:1912192444
Name:PETRONACI, ERIKA LYNN (ARNP)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:LYNN
Last Name:PETRONACI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2600 LAKE LUCIEN DR
Mailing Address - Street 2:SUITE 180
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7233
Mailing Address - Country:US
Mailing Address - Phone:407-875-2080
Mailing Address - Fax:407-875-0518
Practice Address - Street 1:1120 CITRUS TOWER BLVD
Practice Address - Street 2:SUITE 330
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1909
Practice Address - Country:US
Practice Address - Phone:352-241-4298
Practice Address - Fax:352-241-7620
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9233116363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAG476ZMedicare PIN