Healthcare Provider Details

I. General information

NPI: 1912259052
Provider Name (Legal Business Name): TESSIE D ARELLANO-SICAM ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2012
Last Update Date: 10/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

7516 ADVENTURE AVE
NORTH BAY VILLAGE FL
33141-4108
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-6494
  • Fax:
Mailing address:
  • Phone: 786-942-7550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberARNP1086902
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: