Provider Demographics
NPI:1902131253
Name:PICA, JAMIE ALEXANDER (ACNPC-AG)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:ALEXANDER
Last Name:PICA
Suffix:
Gender:M
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DUNMOW CRES
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-3810
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:350 PARRISH ST
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1793
Practice Address - Country:US
Practice Address - Phone:585-396-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1162302103TS0200X
NY431523363L00000X, 363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner