Healthcare Provider Details

I. General information

NPI: 1588596175
Provider Name (Legal Business Name): MS. ERIKA ICE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2026
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6026 ELENA LYNN CT
CHARLOTTE NC
28269-3599
US

IV. Provider business mailing address

6026 ELENA LYNN CT
CHARLOTTE NC
28269-3599
US

V. Phone/Fax

Practice location:
  • Phone: 904-655-1590
  • Fax:
Mailing address:
  • Phone: 904-655-1590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2026017044
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: