Individual
ERICA BERNADETTE FAZZINI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
196871
OR
363AS0400X
Surgical Physician Assistant
Primary
PA196871
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA196871
PA LICENSE NUMBER
OR
Enumeration date
12/02/2019
Last updated
05/23/2022
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