Provider Demographics
NPI:1396020426
Name:VANACORE, VICTORIA (PA-C)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:VANACORE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 S GERMANTOWN RD STE 103
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2862
Mailing Address - Country:US
Mailing Address - Phone:901-754-8880
Mailing Address - Fax:901-754-8883
Practice Address - Street 1:1941 S GERMANTOWN RD STE 103
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2862
Practice Address - Country:US
Practice Address - Phone:901-754-8880
Practice Address - Fax:901-754-8883
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106248363A00000X, 363AS0400X
TN3386363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016646600Medicaid
FL1242841OtherWELLCARE
FL5359596OtherCIGNA
FLP1032516OtherFREEDOM
FLP968867OtherOPTIMUM
FLYJAALOtherBCBS
FL9422829OtherAETNA
FL398528OtherAVMED
FLP01584470OtherRR MEDICARE
FL9422829OtherAETNA