Provider Demographics
NPI:1497743223
Name:PARKS, VICKI LYNN (DNP, ARNP-BC)
Entity Type:Individual
Prefix:DR
First Name:VICKI
Middle Name:LYNN
Last Name:PARKS
Suffix:
Gender:F
Credentials:DNP, ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4328 SAINT ALBANS DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-8025
Mailing Address - Country:US
Mailing Address - Phone:904-607-4023
Mailing Address - Fax:
Practice Address - Street 1:10440 US 1 N UNIT 101
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32095-8459
Practice Address - Country:US
Practice Address - Phone:904-715-4600
Practice Address - Fax:904-342-7922
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1524462363LA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306333000Medicaid
FLP00273346Medicare PIN
FLP44422Medicare UPIN
FLY0422WMedicare PIN
FLP01492924Medicare PIN
FL306333000Medicaid