Provider Demographics
NPI:1942380084
Name:LASECKI, NICOLE PATRICIA (ARNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:PATRICIA
Last Name:LASECKI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3462 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6722
Mailing Address - Country:US
Mailing Address - Phone:954-572-1444
Mailing Address - Fax:954-572-9273
Practice Address - Street 1:2601 SW 37TH AVE
Practice Address - Street 2:SUITE 607
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-2700
Practice Address - Country:US
Practice Address - Phone:305-445-5056
Practice Address - Fax:305-445-2023
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3187792363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner