Healthcare Provider Details

I. General information

NPI: 1902131253
Provider Name (Legal Business Name): JAMIE ALEXANDER PICA ACNPC-AG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2009
Last Update Date: 06/30/2023
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 PARRISH ST
CANANDAIGUA NY
14424-1793
US

IV. Provider business mailing address

10 DUNMOW CRES
FAIRPORT NY
14450-3810
US

V. Phone/Fax

Practice location:
  • Phone: 585-396-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number431523
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number431523
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1162302
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: