Provider Demographics
NPI:1992053144
Name:MCMICKEN, EMMA LOUISE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:EMMA
Middle Name:LOUISE
Last Name:MCMICKEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 ALLAMANDA DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-2926
Mailing Address - Country:US
Mailing Address - Phone:863-644-2204
Mailing Address - Fax:
Practice Address - Street 1:118 ALLAMANDA DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-2926
Practice Address - Country:US
Practice Address - Phone:863-644-2204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 3178492363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP49801Medicare UPIN