Provider Demographics
NPI:1366879439
Name:DICKINSON, HIRAM KARL (ARNP)
Entity type:Individual
Prefix:MR
First Name:HIRAM
Middle Name:KARL
Last Name:DICKINSON
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:KRIS
Other - Middle Name:J
Other - Last Name:SENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1219 S EAST AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2340
Mailing Address - Country:US
Mailing Address - Phone:855-433-2010
Mailing Address - Fax:855-433-2010
Practice Address - Street 1:1219 S EAST AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2340
Practice Address - Country:US
Practice Address - Phone:855-433-2010
Practice Address - Fax:855-433-2010
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9258344363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology