Provider Demographics
NPI:1023244803
Name:PENA, ERICA DENISE (ARNP)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:DENISE
Last Name:PENA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:DENISE
Other - Last Name:SUAREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1475 NW 81ST AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-6224
Mailing Address - Country:US
Mailing Address - Phone:786-320-1216
Mailing Address - Fax:
Practice Address - Street 1:801 MEADOWS RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2346
Practice Address - Country:US
Practice Address - Phone:561-955-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-06
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9578535163W00000X
GARN206475363L00000X, 363LF0000X
FLAPRN11015862363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003120412AMedicaid