Individual
MS. VICKI M BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3657 MADACA LN, TAMPA, FL 33618-2048
(800) 991-6117
Mailing address
3820 NORTHDALE BLVD STE 201, TAMPA, FL 33624-1893
(800) 991-6117
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA9120078
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
051553463
—
AL
01
—
51514981BUR
BLUE CROSS OF ALABAMA
AL
01
—
P00010094
RR MEDICARE
AL
Enumeration date
07/12/2006
Last updated
05/01/2025
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