Provider Demographics
NPI:1306391842
Name:STVICTOR-VIAU, DARLINE
Entity Type:Individual
Prefix:
First Name:DARLINE
Middle Name:
Last Name:STVICTOR-VIAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 RUSSELL AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4532
Mailing Address - Country:US
Mailing Address - Phone:718-312-9388
Mailing Address - Fax:
Practice Address - Street 1:2677 FOREST HILL BLVD STE 112
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33406-5941
Practice Address - Country:US
Practice Address - Phone:718-312-9388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11011827363LA2200X
NY307569363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty