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General NPI Number Information
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NPI Number | 1497478762
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Entity Type | Individual
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Provider Name | VICTORIA VALENTINA BAZAN APRN
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Gender | Female
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Dates
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Enumeration Date | 09/22/2022
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Last Update Date | 09/27/2022
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Provider Practice Location Address
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Address Line | 9347 NW 114TH LN # 3
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City | HIALEAH GARDENS
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State | FL
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Zip | 33018-4269
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Country | US
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Telephone | 786-380-3179
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Fax |
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Provider Business Mailing Address
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Address Line | 9347 NW 114TH LN # 3
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City | HIALEAH GARDENS
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State | FL
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Zip | 33018-4269
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Country | US
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Telephone | 786-380-3179
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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 | 2021097385
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11022075
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License Number State | FL
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