Provider Demographics
NPI:1235630435
Name:GUTIERREZ, VICTORIA NICOLE
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:NICOLE
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:VICTORIA
Other - Middle Name:NICOLE
Other - Last Name:MATHIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3054 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-7424
Mailing Address - Country:US
Mailing Address - Phone:615-550-0091
Mailing Address - Fax:615-550-1397
Practice Address - Street 1:3054 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-7424
Practice Address - Country:US
Practice Address - Phone:615-550-0091
Practice Address - Fax:615-550-1397
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALF12170654363LF0000X
TN24033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily