Provider Demographics
NPI:1790371995
Name:PICKENS, JUSTIN E (APRN)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:E
Last Name:PICKENS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4235 KINGS HIGHWAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33980-8421
Mailing Address - Country:US
Mailing Address - Phone:941-613-1777
Mailing Address - Fax:941-613-1779
Practice Address - Street 1:4235 KINGS HIGHWAY
Practice Address - Street 2:SUITE 103
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-8421
Practice Address - Country:US
Practice Address - Phone:941-613-1777
Practice Address - Fax:941-613-1779
Is Sole Proprietor?:No
Enumeration Date:2020-12-12
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL11010438363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care