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Individual
VANESSA GAMMILL LICKSON
Active
Individual
VANESSA GAMMILL LICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
9301316
FL
363L00000X
Nurse Practitioner
11000074
FL
363LF0000X
Family Nurse Practitioner
Primary
APRN11000074
FL
Other
Enumeration date
10/27/2018
Last updated
01/03/2024
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