Provider Demographics
NPI:1528748605
Name:SCIPIONI, PAUL THOMAS (MSN, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:THOMAS
Last Name:SCIPIONI
Suffix:
Gender:M
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 CORAL TRACE BLVD
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:FL
Mailing Address - Zip Code:32132-6942
Mailing Address - Country:US
Mailing Address - Phone:386-334-4306
Mailing Address - Fax:
Practice Address - Street 1:2583 S VOLUSIA AVE STE 300
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-9129
Practice Address - Country:US
Practice Address - Phone:386-774-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11027653363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty