Provider Demographics
NPI:1558908178
Name:HICKS, TAMMI EVETTE
Entity Type:Individual
Prefix:MISS
First Name:TAMMI
Middle Name:EVETTE
Last Name:HICKS
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 1:714 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-4652
Mailing Address - Country:US
Mailing Address - Phone:850-276-8395
Mailing Address - Fax:
Practice Address - Street 1:714 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-4652
Practice Address - Country:US
Practice Address - Phone:850-276-8395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider