Provider Demographics
NPI:1275798837
Name:HICKS, CASSANDRA GIBBS (ARNP NP-C)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:GIBBS
Last Name:HICKS
Suffix:
Gender:F
Credentials:ARNP NP-C
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:GIBBS
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP LLC
Mailing Address - Street 1:1680 SE LYNGATE DR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-4300
Mailing Address - Country:US
Mailing Address - Phone:772-335-9808
Mailing Address - Fax:772-335-9818
Practice Address - Street 1:1680 SE LYNGATE DR
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34952-4300
Practice Address - Country:US
Practice Address - Phone:772-335-9808
Practice Address - Fax:772-335-9818
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9275760363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDP044AMedicare PIN
FLDO640ZMedicare PIN