Provider Demographics
NPI:1952946535
Name:WICKS, CHRISTINA L (APRN)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:L
Last Name:WICKS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8930 W STATE ROAD 84 # 198
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4456
Mailing Address - Country:US
Mailing Address - Phone:305-331-3871
Mailing Address - Fax:
Practice Address - Street 1:1801 NW 9TH AVE FL 5
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1125
Practice Address - Country:US
Practice Address - Phone:305-331-3871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9236296363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily