Organization
ANTHONY P. NICOSIA MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTHONY PETER NICOSIA M.D. (PRESIDENT)
(772) 332-1757
Entity
Organization
Contact information
Practice address
1502 SE HOLIDAY RD, PORT ST LUCIE, FL 34952-5416
(772) 332-1757
(772) 335-9843
Mailing address
PO BOX 8540, PORT ST LUCIE, FL 34985-8540
(772) 332-1757
(772) 335-9843
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
—
—
207QA0505X
Adult Medicine Physician
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
278035600
—
FL
01
—
91967
BLUE CROSS
FL
01
—
P00476573
RRMCR#
FL
Enumeration date
12/19/2011
Last updated
03/31/2013
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