Provider Demographics
NPI:1790941946
Name:HICKS, JACQUELINE (ST)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 DEER PARK CIR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-3324
Mailing Address - Country:US
Mailing Address - Phone:615-356-7279
Mailing Address - Fax:
Practice Address - Street 1:2011 CHURCH ST
Practice Address - Street 2:PLAZA 1, LOWER LEVEL
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2000
Practice Address - Country:US
Practice Address - Phone:615-515-4018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist