Individual
DR. ANTHONY PETER NICOSIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1502 SE HOLIDAY RD, PORT SAINT LUCIE, FL 34952-5416
(772) 332-1757
(772) 777-3044
Mailing address
PO BOX 8540, PORT SAINT LUCIE, FL 34985-8540
(772) 332-1757
(772) 777-3044
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
ME91689
FL
207QA0000X
Adolescent Medicine (Family Medicine) Physician
ME91689
FL
207QA0505X
Adult Medicine Physician
ME91689
FL
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
ME91689
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0940704
—
NJ
05
—
278035600
—
FL
Enumeration date
10/26/2006
Last updated
10/27/2016
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