Healthcare Provider Details

I. General information

NPI: 1366575698
Provider Name (Legal Business Name): SHEILA CICCONE N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 BREN RD E
MINNETONKA MN
55343-9664
US

IV. Provider business mailing address

4639 PRATT CIR
VERO BEACH FL
32967-7685
US

V. Phone/Fax

Practice location:
  • Phone: 401-525-1821
  • Fax:
Mailing address:
  • Phone: 401-525-1821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number72030
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: