Provider Demographics
NPI:1376388215
Name:DEFALCO, AMINA MARIE (APRN)
Entity type:Individual
Prefix:
First Name:AMINA
Middle Name:MARIE
Last Name:DEFALCO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 SW BUTTERFLY TER
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-1526
Mailing Address - Country:US
Mailing Address - Phone:772-342-2715
Mailing Address - Fax:
Practice Address - Street 1:1300 N LAWNWOOD CIR
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4884
Practice Address - Country:US
Practice Address - Phone:772-302-3977
Practice Address - Fax:877-229-5205
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL11033594363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily