Provider Demographics
NPI:1962867747
Name:PACIFICO, ERICA MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:MARIE
Last Name:PACIFICO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:ERICA
Other - Middle Name:MARIE
Other - Last Name:SPANHAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:222 E MIDDLE COUNTRY RD STE 340
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2814
Mailing Address - Country:US
Mailing Address - Phone:631-393-1620
Mailing Address - Fax:
Practice Address - Street 1:222 E MIDDLE COUNTRY RD STE 340
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2814
Practice Address - Country:US
Practice Address - Phone:631-393-1629
Practice Address - Fax:631-392-8939
Is Sole Proprietor?:No
Enumeration Date:2015-12-22
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019406363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant