Provider Demographics
NPI:1912996380
Name:HICKS, VIOLETA ELIZABETH (NP)
Entity Type:Individual
Prefix:MRS
First Name:VIOLETA
Middle Name:ELIZABETH
Last Name:HICKS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:VIOLETA
Other - Middle Name:ELIZABETH
Other - Last Name:TRAIL HICKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:136 ROPEMAKER LN
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-2018
Mailing Address - Country:US
Mailing Address - Phone:912-897-3100
Mailing Address - Fax:912-898-7975
Practice Address - Street 1:1444 DEAN FOREST RD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-9363
Practice Address - Country:US
Practice Address - Phone:912-964-1531
Practice Address - Fax:912-964-1522
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN097435363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily