Healthcare Provider Details

I. General information

NPI: 1598447609
Provider Name (Legal Business Name): PATESHIA VICKERS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 FAIRWAY DR FL 2
DEERFIELD BEACH FL
33441-1809
US

IV. Provider business mailing address

2582 SW 14TH TER
PAHOKEE FL
33476-2804
US

V. Phone/Fax

Practice location:
  • Phone: 561-985-4188
  • Fax:
Mailing address:
  • Phone: 561-985-4188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN9352228
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: