Healthcare Provider Details

I. General information

NPI: 1639826522
Provider Name (Legal Business Name): NICOLE PACANA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 UNDERWOOD ST FL 4
ORLANDO FL
32806-1110
US

IV. Provider business mailing address

22 UNDERWOOD ST FL 4
ORLANDO FL
32806-1110
US

V. Phone/Fax

Practice location:
  • Phone: 407-310-7283
  • Fax:
Mailing address:
  • Phone: 407-310-7283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: