Provider Demographics
NPI:1194189688
Name:HICKMAN, JOSHUA (DO)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:HICKMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 MICCOSUKEE RD
Mailing Address - Street 2:FSU/TMH INTERNAL MEDICINE RESIDENCY PROGRAM
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5054
Mailing Address - Country:US
Mailing Address - Phone:850-431-7900
Mailing Address - Fax:850-431-7990
Practice Address - Street 1:1300 MICCOSUKEE RD
Practice Address - Street 2:FSU/TMH INTERNAL MEDICINE RESIDENCY PROGRAM
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5054
Practice Address - Country:US
Practice Address - Phone:850-431-7900
Practice Address - Fax:850-431-7990
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLOS16068207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program