Provider Demographics
NPI:1861768541
Name:FORDYCE, TRICELY FINELA (REGISTERED NURSE)
Entity type:Individual
Prefix:MISS
First Name:TRICELY
Middle Name:FINELA
Last Name:FORDYCE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15502 108TH AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11433-1914
Mailing Address - Country:US
Mailing Address - Phone:718-739-4463
Mailing Address - Fax:
Practice Address - Street 1:15502 108TH AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11433-1914
Practice Address - Country:US
Practice Address - Phone:718-739-4463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY551524-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool