Provider Demographics
NPI:1063255099
Name:LICARI, BRIANNA NICOLE
Entity type:Individual
Prefix:DR
First Name:BRIANNA
Middle Name:NICOLE
Last Name:LICARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 ADMIRAL COCHRANE DR APT 2033
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7591
Mailing Address - Country:US
Mailing Address - Phone:631-291-2956
Mailing Address - Fax:
Practice Address - Street 1:13620 REESE BLVD E STE 100
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-6418
Practice Address - Country:US
Practice Address - Phone:704-801-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5020596363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner