Provider Demographics
NPI:1841237377
Name:JILL HICKEY DPM PA
Entity Type:Organization
Organization Name:JILL HICKEY DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:V
Authorized Official - Last Name:HICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:239-436-1999
Mailing Address - Street 1:49 8TH ST N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-6020
Mailing Address - Country:US
Mailing Address - Phone:239-436-1999
Mailing Address - Fax:239-436-3788
Practice Address - Street 1:49 8TH ST N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-6020
Practice Address - Country:US
Practice Address - Phone:239-436-1999
Practice Address - Fax:239-436-3788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4680720001Medicare NSC
FLQ0197Medicare PIN