Provider Demographics
NPI:1659472652
Name:TICKLE, JUNE E (MS, ARNP)
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:E
Last Name:TICKLE
Suffix:
Gender:F
Credentials:MS, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 S US 301
Mailing Address - Street 2:
Mailing Address - City:SUMTERVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:33585-5141
Mailing Address - Country:US
Mailing Address - Phone:352-793-5900
Mailing Address - Fax:352-793-8050
Practice Address - Street 1:1389 S US 301
Practice Address - Street 2:
Practice Address - City:SUMTERVILLE
Practice Address - State:FL
Practice Address - Zip Code:33585-5143
Practice Address - Country:US
Practice Address - Phone:352-793-5900
Practice Address - Fax:352-793-8050
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9232262363LF0000X
CANPF 11478363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2416044Medicaid
NV3116044OtherEPSDT
NVCC6702OtherBC/BS
NV50003861OtherRR MCR
NV3116044OtherEPSDT
NVCC6702OtherBC/BS