Individual
VICKY E DANTZLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
324 RALPH LONG RD, DEFUNIAK SPRINGS, FL 32433-0830
(850) 533-6018
Mailing address
324 RALPH LONG RD, DEFUNIAK SPRINGS, FL 32433-0830
(850) 533-6018
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN3378712
FL
222Q00000X
Developmental Therapist
Primary
RN3378712
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
015798500
—
FL
Enumeration date
11/03/2006
Last updated
06/23/2020
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