Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | ARNP9248532 | FL |
NPI | 1003258591 |
---|---|
Provider Name | Mrs. Victoria Lc Mccullers |
First Address | Pensacola, FL 32513-2699 |
Second Address | Pensacola, FL 32504-8721 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2013 |
Last Update Date | 29/10/2015 |