Healthcare Provider Details

I. General information

NPI: 1760726699
Provider Name (Legal Business Name): RANDALL S HICKS FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 W HIGHWAY 98
PENSACOLA FL
32512-0001
US

IV. Provider business mailing address

6000 W HIGHWAY 98
PENSACOLA FL
32512-0001
US

V. Phone/Fax

Practice location:
  • Phone: 850-530-9960
  • Fax: 630-570-6410
Mailing address:
  • Phone: 850-530-9960
  • Fax: 630-570-6410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number111716
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: