NPI | 1972198802 |
---|---|
Former Name | MARISSA A HICKS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11011915) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11011915) |
Enumeration Date | 2021-03-03 |
Last Update Date | 2022-12-21 |