Provider Demographics
NPI:1801890868
Name:VUCEMILOVIC, VINKICA (MD)
Entity type:Individual
Prefix:
First Name:VINKICA
Middle Name:
Last Name:VUCEMILOVIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2832
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33806-2832
Mailing Address - Country:US
Mailing Address - Phone:727-384-4060
Mailing Address - Fax:
Practice Address - Street 1:6560 9TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-6216
Practice Address - Country:US
Practice Address - Phone:727-384-4060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77878207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL300434100Medicaid
47120ZMedicare ID - Type Unspecified
FL300434100Medicaid