Provider Demographics
NPI:1588245864
Name:HICKS, TOYA TAMIKO (CNA)
Entity type:Individual
Prefix:
First Name:TOYA
Middle Name:TAMIKO
Last Name:HICKS
Suffix:
Gender:
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19954 AVON AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-1557
Mailing Address - Country:US
Mailing Address - Phone:313-782-2228
Mailing Address - Fax:
Practice Address - Street 1:19954 AVON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-1557
Practice Address - Country:US
Practice Address - Phone:313-782-2228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-18
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X
MI372600000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No372600000XNursing Service Related ProvidersAdult Companion