Provider Demographics
NPI:1558917070
Name:FLICKER, BREICA NICHOLE (PA-C)
Entity type:Individual
Prefix:
First Name:BREICA
Middle Name:NICHOLE
Last Name:FLICKER
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:BREICA
Other - Middle Name:NICHOLE
Other - Last Name:BECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:231 GRANITE RUN DRIVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-6823
Mailing Address - Country:US
Mailing Address - Phone:717-560-4200
Mailing Address - Fax:717-560-4159
Practice Address - Street 1:231 GRANITE RUN DRIVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6823
Practice Address - Country:US
Practice Address - Phone:717-560-4200
Practice Address - Fax:717-560-4159
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA005498363A00000X
PAMA062382363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant