Individual
MS. ELIZABETH JOHNSON HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
37 S MAIN ST, WILLISTON, FL 32696-2681
(352) 528-0022
(352) 528-2878
Mailing address
21645 NW 87TH AVENUE RD, MICANOPY, FL 32667-7430
(352) 466-0130
(352) 529-0014
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN1487192
FL
225100000X
Physical Therapist
Primary
PT5183
FL
2255A2300X
Athletic Trainer
AL 36
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
890982200
—
FL
Enumeration date
05/01/2006
Last updated
01/22/2009
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