Basic Information
| Provider Information | |||||||||
| NPI: | 1316390230 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VICKERS | ||||||||
| FirstName: | SONYA | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 TAMPA GENERAL CIR | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336063601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132583309 | ||||||||
| FaxNumber: | 8132514454 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 TAMPA GENERAL CIR | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336063601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132583309 | ||||||||
| FaxNumber: | 8132514454 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2016 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | ARNP9332352 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 018120400 | 05 | FL | MEDICAID |