Provider Demographics
NPI:1316390230
Name:VICKERS, SONYA (ARNP)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:
Last Name:VICKERS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 TAMPA GENERAL CIR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3601
Mailing Address - Country:US
Mailing Address - Phone:813-258-3309
Mailing Address - Fax:813-251-4454
Practice Address - Street 1:5 TAMPA GENERAL CIR
Practice Address - Street 2:SUITE 240
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3601
Practice Address - Country:US
Practice Address - Phone:813-258-3309
Practice Address - Fax:813-251-4454
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9332352363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018120400Medicaid