Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | ME 110766 | FL |
NPI | 1033376371 |
---|---|
Provider Name | Maria Isabel Hicks |
First Address | Maitland, FL 32751-7172 |
Second Address | Tampa, FL 33624-2038 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2008 |
Last Update Date | 12/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004051900 | (05) | FL |
14FH0 | FL BLUE (01) | FL |
592235385 | UNITED HC (01) | FL |
8504884 | CIGNA (01) | FL |
9898744 | AETNA (01) | FL |