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General NPI Number Information
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NPI Number | 1689356685
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Entity Type | Organization
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Legal Business Name | ANDREW M. VICK APRN, L.L.C.
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Dates
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Enumeration Date | 08/01/2023
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Last Update Date | 05/01/2024
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Provider Practice Location Address
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Address Line | 218 HOOVER ROAD
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City | HOLLISTER
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State | FL
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Zip | 32147
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Country | US
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Telephone | 523-963-0413
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Fax |
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Provider Business Mailing Address
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Address Line | 218 HOOVER ROAD PO BOX 825
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City | HOLLISTER
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State | FL
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Zip | 32147
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Country | US
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Telephone | 352-396-3041
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Fax |
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Authorized Official
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Title or Position | LLC OWNER-MEMBER
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Name | ANDREW MARTIN VICK
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Credential | FNP
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Telephone | 352-396-3041
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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