Provider Demographics
NPI:1497478762
Name:BAZAN, VICTORIA VALENTINA (APRN)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:VALENTINA
Last Name:BAZAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9347 NW 114TH LN # 3
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4269
Mailing Address - Country:US
Mailing Address - Phone:786-380-3179
Mailing Address - Fax:
Practice Address - Street 1:9347 NW 114TH LN # 3
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-4269
Practice Address - Country:US
Practice Address - Phone:786-380-3179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-22
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2021097385363LF0000X
FL11022075363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily