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NPI Code Detail

MEDICARE: JENNIFER REBECCA RICKMAN CRNP

MEDICARE: JENNIFER REBECCA RICKMAN CRNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseRN588226PA
2363LF0000XFamily Nurse PractitionerSP19351PA
3363LP2300XPrimary Care Nurse Practitioner11041861FL

General Provider Information

NPI Number : 1932687266
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER REBECCA RICKMAN CRNP
Provider Business Mailing Address
First Line : 14451 MARSALA WAY
Second Line :
City : NAPLES
State : FL
Zip : 34109-3233
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1839 CENTRAL AVE
Second Line :
City : ST PETERSBURG
State : FL
Zip : 33713-9089
Country : US
Telephone Number : 878-201-3312
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2018
Last Update Date : 05/18/2026

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