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General NPI Number Information
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NPI Number | 1780925362
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Entity Type | Individual
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Provider Name | JACQUELINE C TRICARICO PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/07/2013
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Last Update Date | 02/08/2022
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Provider Practice Location Address
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Address Line | 5620 W THUNDERBIRD RD STE B
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City | GLENDALE
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State | AZ
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Zip | 85306-4636
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Country | US
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Telephone | 602-206-6262
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Fax |
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Provider Business Mailing Address
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Address Line | 14598 W WINDSOR AVE
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City | GOODYEAR
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State | AZ
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Zip | 85395-2037
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Country | US
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Telephone | 315-439-8610
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-04192
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | 7785
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License Number State | AZ
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