Provider Demographics
NPI:1114967429
Name:NASRALLAH, VICTOR NASH (PA-C)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:NASH
Last Name:NASRALLAH
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:2025 FRONTIS PLAZA BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5663
Mailing Address - Country:US
Mailing Address - Phone:904-244-3199
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:580 W 8TH ST
Practice Address - Street 2:UFJAX - DEPT. OF MEDICINE (GI)
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6533
Practice Address - Country:US
Practice Address - Phone:904-633-0797
Practice Address - Fax:904-633-0028
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2021-10-20
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Provider Licenses
StateLicense IDTaxonomies
NC101643363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003143088AMedicaid
FL010295600Medicaid
FLHR308ZMedicare PIN
FLP01356887Medicare PIN