Jenna Hicks, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9117214 Issued in FL

Practice address

3507 Lee Blvd Ste 107
Lehigh Acres, FL 33971-1303

Phone

(239) 368-8071

Fax

(239) 368-8074

NPI assigned

May 11, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Jenna Duffy Former name

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Innovative Dermatology and Mohs Surgery LLCGroup PAC ID 7416268255, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Innovative Dermatology and Mohs Surgery LLC

  • Dermatology Physician
  • Lehigh Acres, FL
  • NPI 1487049722
  Medicare reassignment Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1683763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741046400000",
    "number": "1942990957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3507 LEE BLVD STE 107",
            "city": "LEHIGH ACRES",
            "state": "FL",
            "postal_code": "339711303",
            "telephone_number": "239-368-8071",
            "fax_number": "239-368-8074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3507 LEE BLVD STE 107",
            "city": "LEHIGH ACRES",
            "state": "FL",
            "postal_code": "339711303",
            "telephone_number": "239-368-8071",
            "fax_number": "239-368-8074"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8800 Bernwood Pkwy Ste 6",
            "address_purpose": "LOCATION",
            "city": "Bonita Springs",
            "state": "FL",
            "postal_code": "341359527",
            "country_code": "US",
            "telephone_number": "239-464-1433",
            "fax_number": "239-368-8074",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HICKS",
        "first_name": "JENNA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-11",
        "last_updated": "2025-03-04",
        "certification_date": "2025-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9117214",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "118763100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNA",
            "last_name": "DUFFY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Hma
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• Cynthia R Hohman, ARNP
• Holiday CVS LLC

• Physician Assistant in Lehigh Acres, FL
• Providers in Lehigh Acres, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.