Provider Demographics
NPI:1225319783
Name:VICTOR, VENTRICIA (FNP)
Entity Type:Individual
Prefix:
First Name:VENTRICIA
Middle Name:
Last Name:VICTOR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:VENTRICIA
Other - Middle Name:
Other - Last Name:HARRIS-VICTOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:101 PLAZA REAL S APT 916
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-4887
Mailing Address - Country:US
Mailing Address - Phone:631-291-2830
Mailing Address - Fax:561-465-5978
Practice Address - Street 1:2677 FOREST HILL BLVD STE 125
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33406-5941
Practice Address - Country:US
Practice Address - Phone:561-855-8647
Practice Address - Fax:561-855-8872
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9438323363LF0000X
NYF336427-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025168800Medicaid
NY03394543Medicaid