Individual
TYLER DOUGLAS HICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CNIM
Contact information
Practice address
127 W FAIRBANKS AVE # 180, WINTER PARK, FL 32789-4326
(239) 443-8739
Mailing address
127 W FAIRBANKS AVE # 180, WINTER PARK, FL 32789-4326
Taxonomy
Speciality
Code
Description
License number
State
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
Primary
3216
—
Other
Enumeration date
03/08/2018
Last updated
03/08/2018
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