Healthcare Provider Details

I. General information

NPI: 1659472652
Provider Name (Legal Business Name): JUNE E. TICKLE MS, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1389 S US 301
SUMTERVILLE FL
33585-5143
US

IV. Provider business mailing address

1425 S US 301
SUMTERVILLE FL
33585-5141
US

V. Phone/Fax

Practice location:
  • Phone: 352-793-5900
  • Fax: 352-793-8050
Mailing address:
  • Phone: 352-793-5900
  • Fax: 352-793-8050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 9232262
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNPF 11478
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: