Individual
MEIRA MARNA PERNICONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
17416 BROOKSIDE TRACE CT., TAMPA, FL 33647
(813) 974-5275
(813) 908-8835
Mailing address
5922 TARAWOOD DR, ORLANDO, FL 32819-4420
(407) 620-9596
(813) 905-8835
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
ME58939
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003930900
—
FL
01
—
14FX3
BLUE CROSS BLUE SHIELD
FL
Enumeration date
03/28/2007
Last updated
08/16/2022
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