Healthcare Provider Details

I. General information

NPI: 1558827931
Provider Name (Legal Business Name): CLARISSA FLORIVAL-VICTOR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2019
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7809 WISCONSIN AVE
BETHESDA MD
20814-3523
US

IV. Provider business mailing address

7809 WISCONSIN AVE
BETHESDA MD
20814-3523
US

V. Phone/Fax

Practice location:
  • Phone: 301-986-9144
  • Fax: 301-718-5119
Mailing address:
  • Phone: 301-986-9144
  • Fax: 301-718-5119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR277539
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11000232
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: