Provider Demographics
NPI:1649375221
Name:TOTAL P.I.C.C. PA
Entity type:Organization
Organization Name:TOTAL P.I.C.C. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:GAY
Authorized Official - Last Name:FORTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:800-496-6080
Mailing Address - Street 1:2436 NORTH FEDERAL HWY
Mailing Address - Street 2:217
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-6853
Mailing Address - Country:US
Mailing Address - Phone:800-496-6080
Mailing Address - Fax:954-531-1504
Practice Address - Street 1:1309 SE 1ST TERRACE
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:LA
Practice Address - Zip Code:33441-6701
Practice Address - Country:US
Practice Address - Phone:800-496-6080
Practice Address - Fax:954-531-1504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2634552163W00000X, 163WH0200X, 163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Not Answered163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
Not Answered163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Multi-Specialty