Healthcare Provider Details

I. General information

NPI: 1447930607
Provider Name (Legal Business Name): HINA ASLAM TICKNOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 BICHARA BLVD
LADY LAKE FL
32159-7716
US

IV. Provider business mailing address

1114 BICHARA BLVD
LADY LAKE FL
32159-7716
US

V. Phone/Fax

Practice location:
  • Phone: 352-577-0832
  • Fax:
Mailing address:
  • Phone: 352-577-0832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number049064
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number41479
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: