Provider Demographics
NPI:1245423920
Name:PIGGOTT, VICTORIA RENEE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:RENEE
Last Name:PIGGOTT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:VICTORIA
Other - Middle Name:RENEE
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3750 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-2039
Mailing Address - Country:US
Mailing Address - Phone:814-240-3430
Mailing Address - Fax:
Practice Address - Street 1:3720 WEST 26TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506
Practice Address - Country:US
Practice Address - Phone:814-240-3430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-25
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA002991363A00000X
PAMA054918363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant