MEDICARE: VICTORIA PETERSEN

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	1041C0700X	Clinical Social Worker	SW2367	FL

General Provider Information

NPI Number	:	1942662853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA PETERSEN

Provider Business Mailing Address
First Line	:	4101 JIM WALTER BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-5775
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4101 JIM WALTER BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-5775
Country	:	US
Telephone Number	:	813-745-1627
Fax Number	:

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

Provider Enumeration Date	:	03/22/2016
Last Update Date	:	03/22/2016

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Directions to “ VICTORIA PETERSEN ” Practice Location

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