Provider Demographics
NPI:1104878263
Name:FLORES-CARLSON, VICTORIA (CRNA)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:FLORES-CARLSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 ORANGE HILL WAY
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-2637
Mailing Address - Country:US
Mailing Address - Phone:813-390-4628
Mailing Address - Fax:
Practice Address - Street 1:1706 ORANGE HILL WAY
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-2637
Practice Address - Country:US
Practice Address - Phone:813-390-4628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2844722367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG3342OtherBCBS
FLG3342XOtherMEDICARE UPIN W/ FGTBA
FLG3342WOtherMEDICARE UPIN W/ GTBA
FL305723200Medicaid
FLG3342Medicare UPIN