Provider Demographics
NPI:1588357842
Name:HICKS, RACHEL ELIZABETH (RD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:ELIZABETH
Last Name:HICKS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MRS
Other - First Name:RACHEL
Other - Middle Name:ELIZABETH
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:JENKINS
Mailing Address - Street 1:3544 WATERCHASE WAY W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-0803
Mailing Address - Country:US
Mailing Address - Phone:207-217-0917
Mailing Address - Fax:
Practice Address - Street 1:3544 WATERCHASE WAY W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-0803
Practice Address - Country:US
Practice Address - Phone:207-217-0917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND12056133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered