Provider Demographics
NPI:1215163175
Name:RICKETTS, DENISE (MD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:
Last Name:RICKETTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:
Other - Last Name:RICKETTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1713 HWY 441 NORTH
Mailing Address - Street 2:STE C
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972
Mailing Address - Country:US
Mailing Address - Phone:863-467-2159
Mailing Address - Fax:863-763-0681
Practice Address - Street 1:1801 SE HILLMOOR DR STE B-109
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7550
Practice Address - Country:US
Practice Address - Phone:772-337-9473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 114478207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine