Provider Demographics
NPI:1710604582
Name:HICKS, JOANA LYNN (FNP-C)
Entity Type:Individual
Prefix:
First Name:JOANA
Middle Name:LYNN
Last Name:HICKS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14008 SHADOWGLEN BLVD
Mailing Address - Street 2:
Mailing Address - City:MANOR
Mailing Address - State:TX
Mailing Address - Zip Code:78653-3396
Mailing Address - Country:US
Mailing Address - Phone:830-234-7458
Mailing Address - Fax:
Practice Address - Street 1:14008 SHADOWGLEN BLVD
Practice Address - Street 2:
Practice Address - City:MANOR
Practice Address - State:TX
Practice Address - Zip Code:78653-3396
Practice Address - Country:US
Practice Address - Phone:830-234-7458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1097335364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health