Provider Demographics
NPI:1922276450
Name:HICKS, ERIC GERARD (LPN)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:GERARD
Last Name:HICKS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7251 CEDAR CT N APT 207
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-5545
Mailing Address - Country:US
Mailing Address - Phone:727-239-2462
Mailing Address - Fax:727-374-3868
Practice Address - Street 1:7251 CEDAR CT N APT 207
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-5545
Practice Address - Country:US
Practice Address - Phone:727-239-2462
Practice Address - Fax:727-374-3868
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5180403164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse