Individual
BEVERLY WICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNO
Contact information
Practice address
111 GRANADA CT, ORLANDO, FL 32803-3802
(407) 420-1771
Mailing address
2987 PEBBLE CREEK ST, MELBOURNE, FL 32935-7161
(321) 279-8320
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
ARNP421302
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
E3026B
—
FL
Enumeration date
10/19/2005
Last updated
11/17/2008
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