Healthcare Provider Details

I. General information

NPI: 1730044140
Provider Name (Legal Business Name): NP VICKERS ACCESSIBLE WELLNESS AND HEALTHCARE CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
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: 561-291-8874
  • Fax:
Mailing address:
  • Phone: 561-985-4188
  • Fax: 561-985-4188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: PATESHIA VICKERS
Title or Position: NURSE PRACTITIONER
Credential: APRN
Phone: 561-985-4188