Provider Demographics
NPI:1477965713
Name:KOVERZHENKO, VIKTORIYA (ARNP)
Entity Type:Individual
Prefix:
First Name:VIKTORIYA
Middle Name:
Last Name:KOVERZHENKO
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 1:12902 USF MAGNOLIA DR
Mailing Address - Street 2:MMG ATTN: JONATHAN WILLIAMS
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-9416
Mailing Address - Country:US
Mailing Address - Phone:813-745-7365
Mailing Address - Fax:813-449-8119
Practice Address - Street 1:12902 USF MAGNOLIA DR
Practice Address - Street 2:MMG ATTN: JONATHAN WILLIAMS
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-9416
Practice Address - Country:US
Practice Address - Phone:813-745-7365
Practice Address - Fax:813-449-8119
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP9293628363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health