Provider Demographics
NPI:1316767122
Name:VICTOR, DIEUVENA (APRN)
Entity type:Individual
Prefix:
First Name:DIEUVENA
Middle Name:
Last Name:VICTOR
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 1:16204 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-7044
Mailing Address - Country:US
Mailing Address - Phone:305-764-8062
Mailing Address - Fax:
Practice Address - Street 1:16204 ORCHARD DR
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:FL
Practice Address - Zip Code:33470-7044
Practice Address - Country:US
Practice Address - Phone:305-764-8062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11035895207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine