Provider Demographics
NPI:1265782064
Name:NICOPHENE, SUKAINA (ARNP-C)
Entity type:Individual
Prefix:MS
First Name:SUKAINA
Middle Name:
Last Name:NICOPHENE
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10705 OLD SYCAMORE LOOP
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-4989
Mailing Address - Country:US
Mailing Address - Phone:813-785-0849
Mailing Address - Fax:
Practice Address - Street 1:1044 E BRANDON BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5509
Practice Address - Country:US
Practice Address - Phone:813-785-0849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL07250075363LP0808X
FL9267886363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008157200Medicaid
FLP01120210OtherR&R MEDICARE
FLP01120210OtherR&R MEDICARE
FLGT548UMedicare PIN
FLGT548VMedicare PIN
FLGT548XMedicare PIN
FLGT548ZMedicare PIN
FLGT548WMedicare PIN