Individual
ANDREA NICKENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2249 SE GENOA ST, PORT ST LUCIE, FL 34952-7336
(954) 818-1307
Mailing address
2249 SE GENOA ST, PORT ST LUCIE, FL 34952-7336
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA1640
FL
Other
Enumeration date
04/14/2014
Last updated
04/14/2014
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