Provider Demographics
NPI:1811501026
Name:SALAZAR NETTEKOVEN, VICKY PAULINE (APRN)
Entity type:Individual
Prefix:
First Name:VICKY
Middle Name:PAULINE
Last Name:SALAZAR NETTEKOVEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5231 NW 109TH WAY
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2745
Mailing Address - Country:US
Mailing Address - Phone:954-600-8106
Mailing Address - Fax:
Practice Address - Street 1:400 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-1152
Practice Address - Country:US
Practice Address - Phone:954-600-8106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-04
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9427293163WM0102X
FL11008971363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn