Provider Demographics
NPI:1629327960
Name:TEW, VICKI PARISH (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:PARISH
Last Name:TEW
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 1:4121 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-5651
Mailing Address - Country:US
Mailing Address - Phone:850-526-5195
Mailing Address - Fax:850-526-5827
Practice Address - Street 1:4121 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-5651
Practice Address - Country:US
Practice Address - Phone:850-526-5195
Practice Address - Fax:850-526-5827
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1905902363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health