Healthcare Provider Details

I. General information

NPI: 1942801527
Provider Name (Legal Business Name): VICTORIA E ROBERTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2020
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9304 CAMDEN FIELD PKWY
RIVERVIEW FL
33578-0520
US

IV. Provider business mailing address

2306 LONGMORE CIR
VALRICO FL
33596-7865
US

V. Phone/Fax

Practice location:
  • Phone: 813-533-2999
  • Fax:
Mailing address:
  • Phone: 813-625-4335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ12109
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: