Provider Demographics
NPI:1477747178
Name:BORKOWSKI, VICTORIA A
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:A
Last Name:BORKOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:WYATT
Other - Last Name:BORKOWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3524 N FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33565-2533
Mailing Address - Country:US
Mailing Address - Phone:863-808-3988
Mailing Address - Fax:
Practice Address - Street 1:5516 US HIGHWAY 98 N
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-3101
Practice Address - Country:US
Practice Address - Phone:863-858-3993
Practice Address - Fax:863-858-7398
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA47156174400000X, 175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No175L00000XOther Service ProvidersHomeopath