Provider Demographics
NPI:1275937948
Name:SERRANO, NICOLE QUICUTI (PA-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:QUICUTI
Last Name:SERRANO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:QUICUTI
Other - Last Name:EGNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:12061 SW 126TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6107
Mailing Address - Country:US
Mailing Address - Phone:305-790-0941
Mailing Address - Fax:
Practice Address - Street 1:12061 SW 126TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6107
Practice Address - Country:US
Practice Address - Phone:305-790-0941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-09
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108669363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical