Provider Demographics
NPI:1689356685
Name:ANDREW M. VICK APRN, L.L.C.
Entity Type:Organization
Organization Name:ANDREW M. VICK APRN, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC OWNER-MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:VICK
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:352-396-3041
Mailing Address - Street 1:218 HOOVER ROAD
Mailing Address - Street 2:PO BOX 825
Mailing Address - City:HOLLISTER
Mailing Address - State:FL
Mailing Address - Zip Code:32147
Mailing Address - Country:US
Mailing Address - Phone:352-396-3041
Mailing Address - Fax:
Practice Address - Street 1:218 HOOVER ROAD
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:FL
Practice Address - Zip Code:32147
Practice Address - Country:US
Practice Address - Phone:523-963-0413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-01
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care