Provider Demographics
NPI:1508544776
Name:RICKS, MEGAN (WHNP-BC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:RICKS
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3712 BRIAR LN
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-2517
Mailing Address - Country:US
Mailing Address - Phone:352-872-1817
Mailing Address - Fax:
Practice Address - Street 1:5978 POWERS AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2210
Practice Address - Country:US
Practice Address - Phone:904-208-5753
Practice Address - Fax:904-399-2525
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11026826363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health