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General NPI Number Information
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NPI Number | 1104604941
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Entity Type | Individual
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Provider Name | VICTORIA LEIGH HIMES FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/21/2023
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Last Update Date | 09/21/2023
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Provider Practice Location Address
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Address Line | 6006 SE ABSHIER BLVD
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City | BELLEVIEW
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State | FL
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Zip | 34420-4317
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Country | US
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Telephone | 813-385-1288
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Fax |
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Provider Business Mailing Address
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Address Line | 85 SW 132ND RD
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City | WEBSTER
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State | FL
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Zip | 33597-3566
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Country | US
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Telephone | 813-385-1288
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2023058973
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License Number State | FL
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