Provider Demographics
NPI:1952619595
Name:HICKOK, REBECCA J (ARNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:HICKOK
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 1:1840 MEASE DR
Mailing Address - Street 2:STE 200
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-6602
Mailing Address - Country:US
Mailing Address - Phone:727-727-8611
Mailing Address - Fax:727-724-0425
Practice Address - Street 1:1840 MEASE DR
Practice Address - Street 2:STE 200
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-6602
Practice Address - Country:US
Practice Address - Phone:727-727-8611
Practice Address - Fax:727-724-0425
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2214632363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP2214632OtherSTATE LICENSE