MEDICARE: MRS. LOU E. HICKS ARNP

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	363LG0600X	Gerontology Nurse Practitioner	956562	FL

General Provider Information

NPI Number	:	1891752986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LOU E. HICKS ARNP

Provider Business Mailing Address
First Line	:	5000 57TH ST N
Second Line	:
City	:	KENNETH CITY
State	:	FL
Zip	:	33709-3627
Country	:	US
Telephone Number	:	727-398-6661
Fax Number	:	727-398-9370

Provider Business Practice Location Address
First Line	:	BAY PINES VETERANS HEALTH CARE SYSTEM
Second Line	:	1000 BAYPINES BLVD
City	:	BAY PINES
State	:	FL
Zip	:	33744-5005
Country	:	US
Telephone Number	:	727-398-5664
Fax Number	:	727-398-9370

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

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	07/08/2007

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