Provider Demographics
NPI:1750330486
Name:FITZGERALD, VICTORIA H (CRNA)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:H
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:R
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 4918
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32802-4918
Mailing Address - Country:US
Mailing Address - Phone:407-581-9180
Mailing Address - Fax:407-926-9173
Practice Address - Street 1:400 N MILLS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5722
Practice Address - Country:US
Practice Address - Phone:407-581-9180
Practice Address - Fax:407-926-9173
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3170852367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG3821OtherBCBS
FL3070671 00Medicaid
P00276192OtherRAILROAD MEDICARE
FLU5317ZMedicare PIN