Provider Demographics
NPI:1699850776
Name:REED, VICKIE L (PA)
Entity type:Individual
Prefix:
First Name:VICKIE
Middle Name:L
Last Name:REED
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:750 S FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-5767
Mailing Address - Country:US
Mailing Address - Phone:954-421-8181
Mailing Address - Fax:954-426-2967
Practice Address - Street 1:750 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-5767
Practice Address - Country:US
Practice Address - Phone:954-421-8181
Practice Address - Fax:954-426-2967
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE4335ZMedicare ID - Type Unspecified