Provider Demographics
NPI:1093770380
Name:VIKING, MARIA (ARNP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:VIKING
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:863 - 3RD AVENUE NORTH
Mailing Address - Street 2:ST.PETERSBURG FREE CLINIC
Mailing Address - City:ST.PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701
Mailing Address - Country:US
Mailing Address - Phone:727-327-0333
Mailing Address - Fax:727-321-6412
Practice Address - Street 1:863 - 3RD AVENUE NORTH
Practice Address - Street 2:ST.PETERSBURG FREE CLINIC
Practice Address - City:ST.PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701
Practice Address - Country:US
Practice Address - Phone:727-327-0333
Practice Address - Fax:727-321-6412
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2011732363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU49392Medicare ID - Type Unspecified