Individual
TERESA MARIE LICCARDI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
780 5TH AVE S STE 200, NAPLES, FL 34102-6632
(239) 366-2223
Mailing address
PO BOX 1168, NAPLES, FL 34106-1168
(908) 461-8050
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
25MA05756600
NJ
207RN0300X
Nephrology Physician
303252
LA
207RN0300X
Nephrology Physician
Primary
ME127037
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6252109
—
NJ
Enumeration date
04/08/2008
Last updated
08/09/2023
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