Provider Demographics
NPI:1780154500
Name:NOEL-ACCILIEN, ICLEDANNE (APRN)
Entity type:Individual
Prefix:
First Name:ICLEDANNE
Middle Name:
Last Name:NOEL-ACCILIEN
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 1:3916 E JEAN ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-1626
Mailing Address - Country:US
Mailing Address - Phone:813-234-3012
Mailing Address - Fax:
Practice Address - Street 1:3916 E JEAN ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-1626
Practice Address - Country:US
Practice Address - Phone:813-234-3012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11000248363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily