Provider Demographics
NPI:1023056074
Name:HICKEY, JILL V (DPM)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:V
Last Name:HICKEY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2110213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U19688Medicare UPIN
FL65188WMedicare PIN
FL4680720001Medicare NSC