Healthcare Provider Details

I. General information

NPI: 1730898693
Provider Name (Legal Business Name): VICTORIA E KOTCH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 11/21/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CELEBRATION PL
CELEBRATION FL
34747-4970
US

IV. Provider business mailing address

3674 BLUE SAGE LOOP
CLERMONT FL
34714-5160
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-3738
  • Fax:
Mailing address:
  • Phone: 732-433-6411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number9560142
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: