Healthcare Provider Details
I. General information
NPI: 1366893596
Provider Name (Legal Business Name): ARICA N FERGUSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 06/29/2016
Last Update Date: 06/29/2023
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
140 CANAL VIEW BLVD SUITE 103
ROCHESTER NY
14623
US
IV. Provider business mailing address
140 CANAL VIEW BLVD SUITE 103
ROCHESTER NY
14623
US
V. Phone/Fax
- Phone: 585-279-5100
- Fax: 585-424-1008
- Phone: 585-279-5100
- Fax: 585-424-1008
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363AS0400X |
| Taxonomy | Surgical Physician Assistant |
| License Number | 19788 |
| License Number State | NY |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363A00000X |
| Taxonomy | Physician Assistant |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: