Healthcare Provider Details

I. General information

NPI: 1962447029
Provider Name (Legal Business Name): VICTORIA ANN SACCARO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 6TH AVE S DEPT #6500000408
ST PETERSBURG FL
33701-4634
US

IV. Provider business mailing address

601 5TH ST S DEPT #6500002705
ST PETERSBURG FL
33701-4804
US

V. Phone/Fax

Practice location:
  • Phone: 727-767-8480
  • Fax: 727-767-8420
Mailing address:
  • Phone: 727-767-3051
  • Fax: 727-767-4970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME59743
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberME59743
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: