Healthcare Provider Details

I. General information

NPI: 1972055218
Provider Name (Legal Business Name): TASHA MICHELLE HICKS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2016
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11140 W COLONIAL DR STE 1
OCOEE FL
34761-3300
US

IV. Provider business mailing address

11140 W COLONIAL DR STE 1
OCOEE FL
34761-3300
US

V. Phone/Fax

Practice location:
  • Phone: 407-877-6500
  • Fax: 321-203-4612
Mailing address:
  • Phone: 407-877-6500
  • Fax: 321-203-4612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN9298689
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: