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General NPI Number Information
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NPI Number | 1811480387
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Entity Type | Individual
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Provider Name | VICTORIA ANNE MORIN MD
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Gender | Female
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Dates
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Enumeration Date | 06/10/2018
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Last Update Date | 06/10/2018
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Provider Practice Location Address
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Address Line | 1463 TOWN CENTER DR
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City | LAKELAND
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State | FL
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Zip | 33803-7966
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Country | US
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Telephone | 863-686-5859
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Fax |
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Provider Business Mailing Address
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Address Line | 1912 HERITAGE ESTATES DR
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City | LAKELAND
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State | FL
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Zip | 33803-5410
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Country | US
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Telephone | 863-604-7555
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME96336
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License Number State | FL
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