Individual
ELISA ROSARIO ICAZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1700 66TH ST. N., SUITE 510, ST. PETERSBURG, FL 33710-5512
(727) 384-2479
(727) 384-3573
Mailing address
1700 66TH ST. N., SUITE 510, ST. PETERSBURG, FL 33710-5512
(727) 384-2479
(727) 384-3573
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
APRN1701762
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
304992200
—
FL
Enumeration date
05/24/2006
Last updated
10/25/2019
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