Provider Demographics
NPI:1992183552
Name:VICK, ANDREW (FNP)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:VICK
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:352-396-3041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-14
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11000923363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily