Individual
ISABELO IAN DOMINGO VICTORIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ARNP
Contact information
Practice address
4801 S UNIVERSITY DR STE 104, DAVIE, FL 33328-3835
(954) 707-5200
Mailing address
5965 STIRLING RD, PMB 391, DAVIE, FL 33314-7225
(786) 697-0703
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
ARNP9415884
FL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN9415884
FL
Other
Enumeration date
04/07/2018
Last updated
01/22/2026
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