Provider Demographics
NPI:1477070266
Name:BRANOM, VICTORIA BELLE (APRN)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:BELLE
Last Name:BRANOM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:VICTORIA
Other - Middle Name:B
Other - Last Name:BERNHARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1414 KUHL AVE # MP38
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2008
Mailing Address - Country:US
Mailing Address - Phone:321-842-4713
Mailing Address - Fax:
Practice Address - Street 1:12780 WATERFORD LAKES PKWY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-4500
Practice Address - Country:US
Practice Address - Phone:407-384-1053
Practice Address - Fax:407-277-8168
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9344654363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022547600Medicaid