Provider Demographics
NPI:1124412770
Name:THOMAS, VICTORIA (APRN, FNP-BC, RN)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:APRN, FNP-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 GRANDYS LN APT 926
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-2860
Mailing Address - Country:US
Mailing Address - Phone:214-213-0795
Mailing Address - Fax:
Practice Address - Street 1:1614 SCRIPTURE ST STE 200
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-8916
Practice Address - Country:US
Practice Address - Phone:940-591-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-21
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127595363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX409795YKP5Medicare PIN