Provider Demographics
NPI:1174925879
Name:MATHIAS, NAICKA D (PA-C)
Entity type:Individual
Prefix:
First Name:NAICKA
Middle Name:D
Last Name:MATHIAS
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2900 CORPORATE WAY D
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5582
Mailing Address - Fax:954-276-0154
Practice Address - Street 1:4855 W HILLSBORO BLVD
Practice Address - Street 2:SUITE B2
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4356
Practice Address - Country:US
Practice Address - Phone:954-418-1683
Practice Address - Fax:954-418-1698
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2015-08-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA 9108093363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIA349ZMedicare Oscar/Certification