| Doctor Name: | MARYANN HICKEY |
| NPI Number: | 1477654267 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN, APN |
| License Number: | 26NJ00074500 |
| Business Practice Address: | 2703 Ponce Deleon Cvs Minute Clinic St. Augustine, FL - 32084 |
| Business Phone Number: | 1866389272 |
| Business Fax Number: | 4016529787 |
| Mailing Address: | 2703 N. Ponce Deleon, ST AUGUSTINE |
| State: | FL |
| Postal Code: | 320846538 |
| Phone Number: | 8663892727 |
| Fax Number: | |
| NPI Enumeration Date: | 09/26/2006 |
| NPI Last Update Date: | 06/26/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 26NJ00074500 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NJ |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |