Provider Demographics
NPI:1164917266
Name:BRANKER, VICTORIA
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:
Last Name:BRANKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12323 SW 55TH ST
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33330-3312
Mailing Address - Country:US
Mailing Address - Phone:954-515-8943
Mailing Address - Fax:
Practice Address - Street 1:12323 SW 55TH ST
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33330-3312
Practice Address - Country:US
Practice Address - Phone:954-515-8943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-30
Last Update Date:2018-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator