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General NPI Number Information
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NPI Number | 1811203953
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Entity Type | Organization
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Legal Business Name | CASSANDRA GIBBS HICKS ARNP LLC
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Dates
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Enumeration Date | 08/26/2010
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Last Update Date | 04/08/2015
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Provider Practice Location Address
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Address Line | 1680 SE LYNGATE DR
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-4300
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Country | US
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Telephone | 772-335-9808
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Fax | 772-335-9818
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Provider Business Mailing Address
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Address Line | 1680 SE LYNGATE DR
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-4300
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Country | US
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Telephone | 772-335-9808
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Fax | 772-335-9818
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | CASSANDRA HICKS
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Credential | ARNP
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Telephone | 772-216-6750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP9275760
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License Number State | FL
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