Provider Demographics
NPI:1265103543
Name:WESTBROOK, VANICKI (PA-C)
Entity type:Individual
Prefix:
First Name:VANICKI
Middle Name:
Last Name:WESTBROOK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:VANICKI
Other - Middle Name:
Other - Last Name:FLEMING-HARRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:23476 NW 186TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIGH SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32643-0673
Mailing Address - Country:US
Mailing Address - Phone:386-454-0698
Mailing Address - Fax:386-454-0690
Practice Address - Street 1:2233 PARK AVENUE
Practice Address - Street 2:SUITE 403 & 405
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5569
Practice Address - Country:US
Practice Address - Phone:904-688-3000
Practice Address - Fax:904-688-3001
Is Sole Proprietor?:No
Enumeration Date:2021-09-25
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9116939363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant