Provider Demographics
NPI:1073841870
Name:HOLCOMB, VICTORIA JEAN (PA)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:JEAN
Last Name:HOLCOMB
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 E 71ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4871
Mailing Address - Country:US
Mailing Address - Phone:212-606-1128
Mailing Address - Fax:212-606-1138
Practice Address - Street 1:1906 BLAKE AVE
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4227
Practice Address - Country:US
Practice Address - Phone:970-384-7140
Practice Address - Fax:970-384-8133
Is Sole Proprietor?:No
Enumeration Date:2009-12-07
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0005869363A00000X
NY23 014127363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant