Healthcare Provider Details

I. General information

NPI: 1811148570
Provider Name (Legal Business Name): VICTORIA BRILL L.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 09/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 MACKEY AVE
INTERLACHEN FL
32148-7436
US

IV. Provider business mailing address

132 MACKEY AVE
INTERLACHEN FL
32148-7436
US

V. Phone/Fax

Practice location:
  • Phone: 386-684-3689
  • Fax:
Mailing address:
  • Phone: 386-684-3689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW94
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: