Provider Demographics
NPI:1265071658
Name:FARNSWORTH, VICTORIA LOUISE (CRNA)
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:LOUISE
Last Name:FARNSWORTH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 ECLIPSE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-4300
Mailing Address - Country:US
Mailing Address - Phone:843-801-2725
Mailing Address - Fax:
Practice Address - Street 1:9848 N TRYON ST STE 250
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-5512
Practice Address - Country:US
Practice Address - Phone:704-749-5800
Practice Address - Fax:704-626-3237
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-02
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN128770367500000X
NC6842367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC-APN.0001821-CRNAOtherCOLORADO BOARD OF NURSING
TN128770OtherNBCRNA