Provider Demographics
NPI:1972055218
Name:HICKS, TASHA MICHELLE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:TASHA
Middle Name:MICHELLE
Last Name:HICKS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11140 W COLONIAL DR STE 1
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-3300
Mailing Address - Country:US
Mailing Address - Phone:407-877-6500
Mailing Address - Fax:321-203-4612
Practice Address - Street 1:11140 W COLONIAL DR STE 1
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3300
Practice Address - Country:US
Practice Address - Phone:407-877-6500
Practice Address - Fax:321-203-4612
Is Sole Proprietor?:No
Enumeration Date:2016-11-03
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9298689363LF0000X
FLAPRN9298689363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021603000Medicaid