Provider Demographics
NPI:1750301792
Name:PHILLIPS, VICKI BRIDGES (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:BRIDGES
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 WILLOW LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763-5389
Mailing Address - Country:US
Mailing Address - Phone:229-883-2998
Mailing Address - Fax:
Practice Address - Street 1:174 WILLOW LAKE DR
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:GA
Practice Address - Zip Code:31763-5389
Practice Address - Country:US
Practice Address - Phone:229-883-2998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN100106 NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily