Healthcare Provider Details

I. General information

NPI: 1124382635
Provider Name (Legal Business Name): VICTORIA BURGES SWYNENBERG APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VICTORIA LYNN BURGES APRN, FNP-C

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 09/22/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96TH MEDICAL GROUP, 307 BOATNER RD STE 114
EGLIN AFB FL
32542-1302
US

IV. Provider business mailing address

307 BOATNER RD STE 114
EGLIN AFB FL
32542-1302
US

V. Phone/Fax

Practice location:
  • Phone: 850-883-9223
  • Fax: 850-883-9702
Mailing address:
  • Phone: 850-883-9223
  • Fax: 850-883-9702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number904238
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: