Mindy L Pelliccio, ARNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

ARNP 9169095 Issued in FL

Practice address

9611 W Broward Blvd
Plantation, FL 33324-2334

Phone

(954) 967-6400

NPI assigned

Apr 28, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: mpelliccio@pa.trimed.direct-ci.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1303948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706832000000",
    "number": "1467743104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "699 SW 159TH TER",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330271140",
            "telephone_number": "954-881-3699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9611 W BROWARD BLVD",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333242334",
            "telephone_number": "954-967-6400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3501 Johnson St",
            "address_purpose": "LOCATION",
            "city": "Hollywood",
            "state": "FL",
            "postal_code": "33021",
            "country_code": "US",
            "telephone_number": "954-265-6301",
            "fax_number": "954-985-1434",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1117 E Hallandale Beach Blvd",
            "address_purpose": "LOCATION",
            "city": "Hallandale Beach",
            "state": "FL",
            "postal_code": "330094488",
            "country_code": "US",
            "telephone_number": "954-457-8771",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PELLICCIO",
        "first_name": "MINDY",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-28",
        "last_updated": "2024-02-02",
        "certification_date": "2024-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "FL",
            "license": "ARNP 9169095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pediatrix Medical Group of Florida, Inc
• Pediatrix Medical Group of Florida, Inc
• Sonia Patricia Pedraza Rubiano
• Craig Allen Peller, MD
• Owen G Peller, MD
• Carmen Pellot
• Kirsten Kelly Pelosi, ARNP
• Pembroke Dental PLLC
• Cynthia Vanessa Penalva, LMFT
• Radomir Penjevic, DC

• Pediatric Nurse Practitioner in Plantation, FL
• Providers in Plantation, FL by specialty
• Pediatric Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.