Provider Demographics
NPI:1972612232
Name:SICCARDI, PATRICIA ELLEN (ARNP)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ELLEN
Last Name:SICCARDI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ELLEN
Other - Last Name:MAHONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1408 N KILLIAN DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:LAKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33403-1962
Mailing Address - Country:US
Mailing Address - Phone:561-845-2708
Mailing Address - Fax:561-844-4090
Practice Address - Street 1:1408 N KILLIAN DR
Practice Address - Street 2:SUITE 112
Practice Address - City:LAKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33403-1962
Practice Address - Country:US
Practice Address - Phone:561-845-2708
Practice Address - Fax:561-844-4090
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1662092363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health