Individual provider Active NPI

Victor Ian Photos

  • Family Nurse Practitioner
  • St Petersburg, FL
National Provider Identifier
1255145157
Registry record updated Jun 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN11039990 Issued in FL
Practice address
1839 Central Ave
St Petersburg, FL 33713-9089
Phone
(727) 322-1054
NPI assigned
Feb 3, 2025
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 19, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APRN11039990 FL Primary

Addresses

Primary practice location

1839 Central Ave
St Petersburg, FL 33713-9089

Mailing address

1839 Central Ave
St Petersburg, FL 33713-9089
Phone (727) 322-1054

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250822001057 FL Practitioner - Nurse Practitioner 3678073897 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1839 Central Ave
St Petersburg, FL 33713-8900

PO Box
Suite 950
East Lansing, MI 48826

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN11039990FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Health Care of Pinellas LLC CurrentSince Jun 19, 2025 Accepting new patients
Professional Health Care of Pinellas Inc. CurrentSince Jun 19, 2025 Accepting new patients

Locations

1839 Central Ave
St Petersburg, FL 33713
Phone (727) 322-1054

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EIJHAA

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1738540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750291200000",
    "number": "1255145157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1839 CENTRAL AVE",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337139089",
            "telephone_number": "727-322-1054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1839 CENTRAL AVE",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337139089",
            "telephone_number": "727-322-1054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHOTOS",
        "first_name": "VICTOR",
        "middle_name": "IAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-02-03",
        "last_updated": "2025-06-19",
        "certification_date": "2025-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN11039990",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.