Healthcare Provider Details

I. General information

NPI: 1801890868
Provider Name (Legal Business Name): VINKICA VUCEMILOVIC MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6560 9TH AVE N
ST PETERSBURG FL
33710-6216
US

IV. Provider business mailing address

PO BOX 2832
LAKELAND FL
33806-2832
US

V. Phone/Fax

Practice location:
  • Phone: 727-384-4060
  • Fax:
Mailing address:
  • Phone: 727-384-4060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME77878
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: