Provider Demographics
NPI:1093343675
Name:AMBO PECHACEK, NICAH ALICIA (DNP, CRNA)
Entity type:Individual
Prefix:MRS
First Name:NICAH
Middle Name:ALICIA
Last Name:AMBO PECHACEK
Suffix:
Gender:F
Credentials:DNP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2453 SWEET OAK ST
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-7607
Mailing Address - Country:US
Mailing Address - Phone:305-519-1625
Mailing Address - Fax:
Practice Address - Street 1:851 TRAFALGAR CT
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4132
Practice Address - Country:US
Practice Address - Phone:407-667-0444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9373151163WC0200X
FLAPRN11013562367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9373151OtherRN LICENSE