Individual
DEBRA WICKLIFFE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
134 NW OLIVE GLN, LAKE CITY, FL 32055-9210
(386) 965-2770
(386) 754-2770
Mailing address
134 NW OLIVE GLN, LAKE CITY, FL 32055-9210
(386) 965-2770
(386) 965-2770
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
6908802996
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6908802965
—
FL
Enumeration date
09/27/2007
Last updated
09/27/2007
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