Basic Information
| Provider Information | |||||||||
| NPI: | 1154619633 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | VICTORIA | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9033 | ||||||||
| Address2: | |||||||||
| City: | STUART | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349959033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7727812799 | ||||||||
| FaxNumber: | 7727812716 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 SE OSCEOLA ST | ||||||||
| Address2: | STE 201 | ||||||||
| City: | STUART | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349942334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7724192137 | ||||||||
| FaxNumber: | 7724192138 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2011 | ||||||||
| LastUpdateDate: | 08/27/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | ARNP9179405 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 004372400 | 05 | FL | MEDICAID | Y09J4 | 01 | FL | BLUE CROSS/BLUE SHIELD | OTHER | FS036Y | 01 | FL | MEDICARE PTAN - LEESBURG | OTHER | FS036Z | 01 | FL | MEDICARE PTAN - STUART | OTHER | FS036W | 01 | FL | MEDICARE PTAN - CITRUS | OTHER |