Provider Demographics
NPI:1356185409
Name:VICTORIN, JIMMY
Entity type:Individual
Prefix:
First Name:JIMMY
Middle Name:
Last Name:VICTORIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9283 ROCK HARBOUR WAY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33637-5320
Mailing Address - Country:US
Mailing Address - Phone:352-424-8040
Mailing Address - Fax:
Practice Address - Street 1:9283 ROCK HARBOUR WAY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33637-5320
Practice Address - Country:US
Practice Address - Phone:352-424-8040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9593325163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse