Provider Demographics
NPI:1588008569
Name:TREMBLY, VICTORIA L (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:L
Last Name:TREMBLY
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 1:1019 VALMEYER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-4123
Mailing Address - Country:US
Mailing Address - Phone:618-205-7170
Mailing Address - Fax:
Practice Address - Street 1:1019 VALMEYER RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236-4123
Practice Address - Country:US
Practice Address - Phone:618-205-7170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-22
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085004646363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant