Healthcare Provider Details

I. General information

NPI: 1689301699
Provider Name (Legal Business Name): HANNAH LYNN HICKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2022
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4107 W SPRUCE ST STE 100
TAMPA FL
33607-2346
US

IV. Provider business mailing address

4107 W SPRUCE ST STE 100
TAMPA FL
33607-2346
US

V. Phone/Fax

Practice location:
  • Phone: 813-636-8811
  • Fax: 813-636-8855
Mailing address:
  • Phone: 813-636-8811
  • Fax: 813-636-8855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH27924
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: