Provider Demographics
NPI:1366463614
Name:HICKS, ANA (MD)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 MERRIMAC AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-1850
Mailing Address - Country:US
Mailing Address - Phone:904-346-0050
Mailing Address - Fax:904-346-0080
Practice Address - Street 1:1510 RIVERPLACE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-9017
Practice Address - Country:US
Practice Address - Phone:904-346-0050
Practice Address - Fax:904-346-0080
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89985207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269889700Medicaid
FL43169ZMedicare ID - Type UnspecifiedMEDICARE NUMBER
FL269889700Medicaid