Provider Demographics
NPI:1699746099
Name:HICKEY, PATRICK E (ARNP)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:E
Last Name:HICKEY
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1773 W SAINT MARYS RD STE 105
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2654
Mailing Address - Country:US
Mailing Address - Phone:520-622-8357
Mailing Address - Fax:520-622-1028
Practice Address - Street 1:1773 W SAINT MARYS RD STE 105
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2654
Practice Address - Country:US
Practice Address - Phone:520-622-8357
Practice Address - Fax:520-622-1028
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3122672363LF0000X
FLARNP3122672363LP0808X
AZMSL3122672FL363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006742000Medicaid
U0348AMedicare ID - Type Unspecified
FL006742000Medicaid