| Denise Ricketts | |
|
1801 Se Hillmoor Dr Ste A-102 Port St Lucie FL 34952-7545 | |
| (772) 249-2494 | |
| (772) 249-3113 |
| Full Name | Denise Ricketts |
|---|---|
| Speciality | Family Medicine |
| Location | 1801 Se Hillmoor Dr Ste A-102, Port St Lucie, Florida |
| Authorized Official Name and Position | Denise Ricketts (OWNER) |
| Authorized Official Contact | 7863902290 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Denise Ricketts 5000 W Midway Rd Unit 12127 Fort Pierce FL 34979-8007 Ph: (786) 390-2290 | Denise Ricketts 1801 Se Hillmoor Dr Ste A-102 Port St Lucie FL 34952-7545 Ph: (772) 249-2494 |
| NPI Number | 1255893343 |
|---|---|
| Provider Enumeration Date | 04/05/2019 |
| Last Update Date | 12/28/2021 |
| Medicare PECOS PAC ID | 7517388945 |
|---|---|
| Medicare Enrollment ID | O20200610002179 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255893343 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Denise Ricketts |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215163175 PECOS PAC ID: 8426213067 Enrollment ID: I20130510000450 |
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