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General NPI Number Information
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NPI Number | 1801076112
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Entity Type | Organization
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Legal Business Name | STEPHEN T. HICKEY, M.D., P.A.
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Dates
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Enumeration Date | 11/05/2007
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Last Update Date | 11/05/2007
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Provider Practice Location Address
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Address Line | 335 11TH AVE N
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-7251
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Country | US
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Telephone | 904-242-0422
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Fax | 904-242-0241
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Provider Business Mailing Address
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Address Line | 335 11TH AVE N
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-7251
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Country | US
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Telephone | 904-242-0422
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Fax | 904-242-0241
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Authorized Official
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Title or Position | DOCTOR'S WIFE
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Name | MRS. CARRIE HICKEY
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Credential | R.N.
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Telephone | 904-242-0422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | ME0055724
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License Number State | FL
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