Individual
DR. HOLLIE JO HICKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
655 W 8TH ST, JACKSONVILLE, FL 32209-6511
(904) 633-0130
Mailing address
PO BOX 44008, UFJP PROVIDER ENROLLMENT, JACKSONVILLE, FL 32231-4008
(904) 244-3660
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
OS9337
FL
390200000X
Student in an Organized Health Care Education/Training Program
1957
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003106713A
—
GA
05
—
003305500
—
FL
Enumeration date
12/02/2005
Last updated
05/03/2011
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