Provider Demographics
NPI:1043905664
Name:HICKERSON, NATALIE K (MD)
Entity type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:K
Last Name:HICKERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:801 S MIAMI AVE UNIT 3607
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-4537
Mailing Address - Country:US
Mailing Address - Phone:305-243-4472
Mailing Address - Fax:
Practice Address - Street 1:1600 NW 10TH AVE # 2023A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1015
Practice Address - Country:US
Practice Address - Phone:305-243-4472
Practice Address - Fax:305-243-6191
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZR80205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine