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General NPI Number Information
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NPI Number | 1093343675
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Entity Type | Individual
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Provider Name | NICAH ALICIA AMBO PECHACEK DNP, CRNA
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Gender | Female
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Dates
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Enumeration Date | 03/30/2020
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Last Update Date | 08/07/2024
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Provider Practice Location Address
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Address Line | 851 TRAFALGAR CT
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City | MAITLAND
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State | FL
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Zip | 32751-4132
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Country | US
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Telephone | 407-667-0444
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Fax |
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Provider Business Mailing Address
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Address Line | 2453 SWEET OAK ST
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City | OCOEE
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State | FL
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Zip | 34761-7607
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Country | US
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Telephone | 305-519-1625
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 9373151
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | APRN11013562
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License Number State | FL
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