Provider Demographics
NPI:1487161022
Name:YANCICH, PRISCILLE (NP-C)
Entity type:Individual
Prefix:
First Name:PRISCILLE
Middle Name:
Last Name:YANCICH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 BRIDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:HEATHROW
Mailing Address - State:FL
Mailing Address - Zip Code:32746-4103
Mailing Address - Country:US
Mailing Address - Phone:407-474-7972
Mailing Address - Fax:
Practice Address - Street 1:2725 REBECCA LN STE 105
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8350
Practice Address - Country:US
Practice Address - Phone:386-775-0736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9347050363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner