Provider Demographics
NPI:1558810143
Name:BOISSELLE, VICTORIA ALICE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:ALICE
Last Name:BOISSELLE
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 1:2818 CYPRESS RIDGE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-6306
Mailing Address - Country:US
Mailing Address - Phone:813-712-5700
Mailing Address - Fax:
Practice Address - Street 1:2818 CYPRESS RIDGE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6306
Practice Address - Country:US
Practice Address - Phone:813-712-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-24
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109840363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant