Provider Demographics
NPI:1336571777
Name:RADCLIFFE-HENRY, ERICA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:
Last Name:RADCLIFFE-HENRY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15250 SW 100TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1685
Mailing Address - Country:US
Mailing Address - Phone:305-773-6565
Mailing Address - Fax:305-238-8356
Practice Address - Street 1:15250 SW 100TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-1685
Practice Address - Country:US
Practice Address - Phone:305-773-6565
Practice Address - Fax:305-238-8356
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101377363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical