Provider Demographics
NPI:1306114483
Name:SORRELL, VICKIE LYNN (FNP-BC)
Entity type:Individual
Prefix:
First Name:VICKIE
Middle Name:LYNN
Last Name:SORRELL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WARRIOR WAY
Mailing Address - Street 2:
Mailing Address - City:BELLE
Mailing Address - State:WV
Mailing Address - Zip Code:25015-1356
Mailing Address - Country:US
Mailing Address - Phone:304-949-3591
Mailing Address - Fax:
Practice Address - Street 1:4770 S RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4544
Practice Address - Country:US
Practice Address - Phone:386-761-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV58087163W00000X
FL9420904163W00000X, 363LF0000X
WV2011007183363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse