Provider Demographics
NPI:1669848578
Name:SMITH, VICTORIA ANN (RN, FNP-C)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 KIRKVILLE RD.
Mailing Address - Street 2:SUITE A
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9305
Mailing Address - Country:US
Mailing Address - Phone:315-463-2013
Mailing Address - Fax:315-463-2019
Practice Address - Street 1:6700 KIRKVILLE RD.
Practice Address - Street 2:SUITE A
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9305
Practice Address - Country:US
Practice Address - Phone:315-463-2013
Practice Address - Fax:315-463-2019
Is Sole Proprietor?:No
Enumeration Date:2015-08-14
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339723363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily