Healthcare Provider Details

I. General information

NPI: 1093770380
Provider Name (Legal Business Name): MARIA VIKING ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 10/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

863 - 3RD AVENUE NORTH ST.PETERSBURG FREE CLINIC
ST.PETERSBURG FL
33701
US

IV. Provider business mailing address

863 - 3RD AVENUE NORTH ST.PETERSBURG FREE CLINIC
ST.PETERSBURG FL
33701
US

V. Phone/Fax

Practice location:
  • Phone: 727-327-0333
  • Fax: 727-321-6412
Mailing address:
  • Phone: 727-327-0333
  • Fax: 727-321-6412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP2011732
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: