Healthcare Provider Details

I. General information

NPI: 1497743223
Provider Name (Legal Business Name): VICKI LYNN PARKS DNP, ARNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 09/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10440 US 1 N UNIT 101
ST AUGUSTINE FL
32095-8459
US

IV. Provider business mailing address

4328 SAINT ALBANS DR
JACKSONVILLE FL
32257-8025
US

V. Phone/Fax

Practice location:
  • Phone: 904-715-4600
  • Fax: 904-342-7922
Mailing address:
  • Phone: 904-607-4023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP 1524462
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 1524462
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: