Healthcare Provider Details

I. General information

NPI: 1184254047
Provider Name (Legal Business Name): KRISTINA ANN RICKMAN-SYKES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2020
Last Update Date: 09/01/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10564 NW SR 20 SUITE #2
BRISTOL FL
32321
US

IV. Provider business mailing address

PO BOX 443
HOSFORD FL
32334-0443
US

V. Phone/Fax

Practice location:
  • Phone: 850-447-4644
  • Fax: 850-655-8951
Mailing address:
  • Phone: 850-447-4644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11005522
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: