Organization
ANTHONY P. NICOSIA MD LLC
Active
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
Update your record
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