Provider Demographics
NPI:1134234669
Name:SICKINGER, ANNE MARIE (ARNP)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:SICKINGER
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 1:511 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-2734
Mailing Address - Country:US
Mailing Address - Phone:904-551-0760
Mailing Address - Fax:904-745-3793
Practice Address - Street 1:511 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202-2734
Practice Address - Country:US
Practice Address - Phone:904-551-0760
Practice Address - Fax:904-745-3793
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2101032363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL768283200Medicaid
FLU4274ZMedicare PIN
FLU4274Medicare ID - Type Unspecified
FL768283200Medicaid