Hickman, Johntavia K
Hickman, Johntavia K is an sole proprietor health care provider with primary practice located at 10471 Thornberry Dr , Spring Hill FL 34608-2829. She recently has only one registered license in Ambulatory Health Care Facilities / Developmental Disabilities, which is considered as her primary health care specialty. Hickman, Johntavia K can be contacted via phone (414) 930-6176.Contact Information
Primary practice address
10471 Thornberry Dr
Spring Hill FL 34608-2829
Phone: (414) 930-6176
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Ambulatory Health Care Facilities / Developmental Disabilities | 261QD1600X | Florida |
Profile Details
| NPI number | 1184384984 |
|---|---|
| LBN Legal business name | Hickman, Johntavia K |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Dec 21st, 2021 |
| Last updated | Dec 21st, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1184384984 | NPPES |
| Florida | MEDICAID | 862745324 |
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