Provider Demographics
NPI:1164147104
Name:AVERILL, VICTORIA ALICIA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ALICIA
Last Name:AVERILL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 QUEENS PLZ N FL 10
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-4022
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:32 COURT ST STE 302
Practice Address - Street 2:
Practice Address - City:BROOKLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11201-4408
Practice Address - Country:US
Practice Address - Phone:718-408-4906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY351000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily