Basic Information
| Provider Information | |||||||||
| NPI: | 1275798837 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HICKS | ||||||||
| FirstName: | CASSANDRA | ||||||||
| MiddleName: | GIBBS | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | ARNP NP-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HICKS | ||||||||
| OtherFirstName: | CASSANDRA | ||||||||
| OtherMiddleName: | GIBBS | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | ARNP LLC | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1680 SE LYNGATE DR | ||||||||
| Address2: | |||||||||
| City: | PORT SAINT LUCIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349524300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7723359808 | ||||||||
| FaxNumber: | 7723359818 | ||||||||
| Practice Location | |||||||||
| Address1: | 1680 SE LYNGATE DR | ||||||||
| Address2: | |||||||||
| City: | FORT PIERCE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349524300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7723359808 | ||||||||
| FaxNumber: | 7723359818 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2008 | ||||||||
| LastUpdateDate: | 04/08/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | ARNP9275760 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.