Provider Demographics
NPI:1558247775
Name:NICOSIA, KARYN A
Entity type:Individual
Prefix:
First Name:KARYN
Middle Name:A
Last Name:NICOSIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 466
Mailing Address - Street 2:
Mailing Address - City:NORTH BEACH
Mailing Address - State:MD
Mailing Address - Zip Code:20714-0466
Mailing Address - Country:US
Mailing Address - Phone:253-970-7152
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 980
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-0980
Practice Address - Country:US
Practice Address - Phone:443-771-0077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCPC-A390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program