Provider Demographics
NPI:1982251229
Name:HICKS, CINDY (CNA)
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 SE DAMASK AVE
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-4013
Mailing Address - Country:US
Mailing Address - Phone:772-475-4358
Mailing Address - Fax:
Practice Address - Street 1:922 SE DAMASK AVE
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-4013
Practice Address - Country:US
Practice Address - Phone:772-475-4358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFLMedicaid