Individual
MS. ELIZABETH MANONGDO HICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
4500 SAN PABLO RD S, JACKSONVILLE, FL 32224-1865
(904) 953-2000
Mailing address
4500 SAN PABLO RD S, JACKSONVILLE, FL 32224-1865
(904) 953-2000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
ARNP3246722
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
302842900
—
FL
01
—
430041295
RAILROAD MEDICARE
FL
01
—
G2277
BLUECROSS/BLUESHIELD
FL
Enumeration date
11/05/2005
Last updated
11/22/2010
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