Healthcare Provider Details

I. General information

NPI: 1073343307
Provider Name (Legal Business Name): VICTORIA RITZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2024
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 QUARTZ PL
ST AUGUSTINE FL
32086-0269
US

IV. Provider business mailing address

50 QUARTZ PL
ST AUGUSTINE FL
32086-0269
US

V. Phone/Fax

Practice location:
  • Phone: 352-620-4630
  • Fax:
Mailing address:
  • Phone: 352-620-4630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11034187
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: