Healthcare Provider Details

I. General information

NPI: 1780595660
Provider Name (Legal Business Name): KRISTIN VICTORY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8270 WOODLAND CENTER BLVD
TAMPA FL
33614-2401
US

IV. Provider business mailing address

8270 WOODLAND CENTER BLVD
TAMPA FL
33614-2401
US

V. Phone/Fax

Practice location:
  • Phone: 855-227-3574
  • Fax:
Mailing address:
  • Phone: 931-349-4043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number207751
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: