MEDICARE: ROSE MARIE VICTOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11040668	FL

General Provider Information

NPI Number	:	1619867710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSE MARIE VICTOR

Provider Business Mailing Address
First Line	:	7379 HEATHLEY DR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-7730
Country	:	US
Telephone Number	:	786-329-1888
Fax Number	:	786-329-1888

Provider Business Practice Location Address
First Line	:	7379 HEATHLEY DR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-7730
Country	:	US
Telephone Number	:	786-329-1888
Fax Number	:	786-329-1888

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2025
Last Update Date	:	07/09/2025

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Directions to “ ROSE MARIE VICTOR ” Practice Location

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