Provider Demographics
NPI:1972086106
Name:PEDICINI, CARMELA MARIE (LPN)
Entity type:Individual
Prefix:MS
First Name:CARMELA
Middle Name:MARIE
Last Name:PEDICINI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4658 NORTHWOOD TER
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34234-5051
Mailing Address - Country:US
Mailing Address - Phone:941-228-7303
Mailing Address - Fax:
Practice Address - Street 1:4658 NORTHWOOD TER
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34234-5051
Practice Address - Country:US
Practice Address - Phone:941-228-7303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1326891164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse