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General NPI Number Information
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NPI Number | 1639877053
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Entity Type | Organization
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Legal Business Name | VB MED LLC
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Dates
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Enumeration Date | 02/16/2023
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Last Update Date | 02/16/2023
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Provider Practice Location Address
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Address Line | 12230 LEGACY BRIGHT ST
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City | RIVERVIEW
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State | FL
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Zip | 33578-4069
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Country | US
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Telephone | 813-575-0363
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Fax | 813-669-5614
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Provider Business Mailing Address
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Address Line | 12230 LEGACY BRIGHT ST
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City | RIVERVIEW
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State | FL
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Zip | 33578-4069
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Country | US
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Telephone | 813-575-0363
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Fax | 813-669-5614
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Authorized Official
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Title or Position | PRESIDENT
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Name | VICTORIA ALICE BOISSELLE
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Credential | PA
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Telephone | 813-575-0363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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