Healthcare Provider Details

I. General information

NPI: 1275159733
Provider Name (Legal Business Name): VICTORIA SUSAN WAICUS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2020
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 SILVER CIR
EDGEWATER FL
32141-5114
US

IV. Provider business mailing address

303 N CLYDE MORRIS BLVD CREDENTIAL SERVICES
DAYTONA BEACH FL
32114-2709
US

V. Phone/Fax

Practice location:
  • Phone: 386-690-6923
  • Fax:
Mailing address:
  • Phone: 386-425-2285
  • Fax: 386-425-7522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11007654
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11007654
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: