Provider Demographics
NPI:1861221905
Name:RICKER, JESYKA REBECCA (IBCLC)
Entity type:Individual
Prefix:
First Name:JESYKA
Middle Name:REBECCA
Last Name:RICKER
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:JESYKA
Other - Middle Name:REBECCA
Other - Last Name:GARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8310 FISHERMANS POINTE DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33637-1842
Mailing Address - Country:US
Mailing Address - Phone:904-226-7356
Mailing Address - Fax:
Practice Address - Street 1:8310 FISHERMANS POINTE DR
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33637-1842
Practice Address - Country:US
Practice Address - Phone:904-226-7356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL-315478174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN