Provider Demographics
NPI:1932448321
Name:HICKS, MARTHA MICHELLE (ARNP)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:MICHELLE
Last Name:HICKS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:
Other - Last Name:MURPHY, MCNEIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP - PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3199
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:1833 BOULEVARD
Practice Address - Street 2:UFJP - CHFM - SHANDS TOTAL CARE CLINIC
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-4382
Practice Address - Country:US
Practice Address - Phone:904-383-1040
Practice Address - Fax:904-244-8952
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9237030363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008279100Medicaid
FLGZ748ZMedicare PIN
FLGZ748YMedicare PIN