Provider Demographics
NPI:1215396395
Name:HILLAERT, VICTOR (CRNP)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:HILLAERT
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9125 BASSWOOD RUN
Mailing Address - Street 2:
Mailing Address - City:BEL ALTON
Mailing Address - State:MD
Mailing Address - Zip Code:20611-3129
Mailing Address - Country:US
Mailing Address - Phone:443-880-8096
Mailing Address - Fax:
Practice Address - Street 1:125 FAIRGROUND RD
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4167
Practice Address - Country:US
Practice Address - Phone:410-846-6608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR199804163W00000X, 363LF0000X
FL9447760363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health