| Jennifer Tickal, Psy.d., P.a. | |
|
1555 N Maitland Ave Maitland FL 32751-3325 | |
| (813) 563-5676 | |
| Not Available |
| Full Name | Jennifer Tickal, Psy.d., P.a. |
|---|---|
| Speciality | Psychologist |
| Location | 1555 N Maitland Ave, Maitland, Florida |
| Authorized Official Name and Position | Jennifer Tickal (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 3212176086 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jennifer Tickal, Psy.d., P.a. 2328 Foliage Oak Ter Oviedo FL 32766-7021 Ph: (321) 217-6086 | Jennifer Tickal, Psy.d., P.a. 1555 N Maitland Ave Maitland FL 32751-3325 Ph: (813) 563-5676 |
| NPI Number | 1023477221 |
|---|---|
| Provider Enumeration Date | 02/16/2016 |
| Last Update Date | 01/18/2021 |
| Certification Date | 01/18/2021 |
| Medicare PECOS PAC ID | 2062701253 |
|---|---|
| Medicare Enrollment ID | O20160511000689 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023477221 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PY8723 (Florida) | Primary |
| Provider Name | Jennifer L Tickal |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1073823266 PECOS PAC ID: 1052614724 Enrollment ID: I20160408000394 |
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