1639227218 NPI number — MS. MARGARITA BETHZABE TICONA ARNP

Table of content: MS. MARGARITA BETHZABE TICONA ARNP (NPI 1639227218)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639227218 NPI number — MS. MARGARITA BETHZABE TICONA ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TICONA
Provider First Name:
MARGARITA
Provider Middle Name:
BETHZABE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639227218
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4855 W HILLSBORO BLVD
Provider Second Line Business Mailing Address:
SUITE B2
Provider Business Mailing Address City Name:
COCONUT CREEK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33073
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-418-1683
Provider Business Mailing Address Fax Number:
954-418-1698

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 E HALLANDALE BEACH BLVD
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
HALLANDALE BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-458-2572
Provider Business Practice Location Address Fax Number:
954-354-8151
Provider Enumeration Date:
01/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  ARNP9281094 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: 9281094 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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