Provider Demographics
NPI:1790377455
Name:JOHNSON, VICKY DEES (RN)
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:DEES
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:VICKY
Other - Middle Name:LYNN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1921 CAPITAL CIR NE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4492
Mailing Address - Country:US
Mailing Address - Phone:850-575-4998
Mailing Address - Fax:
Practice Address - Street 1:2366 BRIDA LANE APT 102
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-3244
Practice Address - Country:US
Practice Address - Phone:850-294-7244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9221904163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice