MEDICARE: SABRINA MICKENS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171WH0202X	Home Modifications Contractor		FL

General Provider Information

NPI Number	:	1386578763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SABRINA MICKENS

Provider Business Mailing Address
First Line	:	7650 SENTRY OAK CIR W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-2324
Country	:	US
Telephone Number	:	904-349-2695
Fax Number	:	904-339-9027

Provider Business Practice Location Address
First Line	:	7650 SENTRY OAK CIR W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-2324
Country	:	US
Telephone Number	:	904-349-2695
Fax Number	:	904-339-9027

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2026
Last Update Date	:	06/10/2026

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