Provider Demographics
NPI:1598447609
Name:VICKERS, PATESHIA (APRN)
Entity Type:Individual
Prefix:
First Name:PATESHIA
Middle Name:
Last Name:VICKERS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38811 JAMES WHEELER WAY
Mailing Address - Street 2:
Mailing Address - City:BELLE GLADE
Mailing Address - State:FL
Mailing Address - Zip Code:33430-5301
Mailing Address - Country:US
Mailing Address - Phone:561-712-2953
Mailing Address - Fax:
Practice Address - Street 1:38811 JAMES WHEELER WAY
Practice Address - Street 2:
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-5301
Practice Address - Country:US
Practice Address - Phone:561-712-2953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9352228363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty