Provider Demographics
NPI:1144339383
Name:PALICKA, MATTHEW JAMES (ARNP)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:JAMES
Last Name:PALICKA
Suffix:
Gender:M
Credentials:ARNP
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Mailing Address - Street 1:6101 PINE RIDGE RD
Mailing Address - Street 2:DESK 12/13
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-3900
Mailing Address - Country:US
Mailing Address - Phone:239-263-0849
Mailing Address - Fax:239-263-2376
Practice Address - Street 1:399 9TH ST N
Practice Address - Street 2:SUITE 300
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5820
Practice Address - Country:US
Practice Address - Phone:239-436-5634
Practice Address - Fax:239-649-1290
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-10-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP3209042363L00000X
NC5018574363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLYQ4QTOtherBCBS FL
FL002474000Medicaid