Provider Demographics
NPI:1538269469
Name:NIEMIEC, MARICCA G (APRN)
Entity type:Individual
Prefix:MS
First Name:MARICCA
Middle Name:G
Last Name:NIEMIEC
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARICCA
Other - Middle Name:
Other - Last Name:GALANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:550 E STATE ROAD 434
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-5222
Mailing Address - Country:US
Mailing Address - Phone:407-381-7367
Mailing Address - Fax:407-331-6758
Practice Address - Street 1:550 E STATE ROAD 434
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5222
Practice Address - Country:US
Practice Address - Phone:407-381-7367
Practice Address - Fax:407-331-6758
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3293642363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily