Provider Demographics
NPI:1598448821
Name:AMBROSIO-SLADE, VICTORIA (MSN, APRN, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:
Last Name:AMBROSIO-SLADE
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 NE 18TH ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-5227
Mailing Address - Country:US
Mailing Address - Phone:305-282-8136
Mailing Address - Fax:
Practice Address - Street 1:428 NE 18TH ST
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-5227
Practice Address - Country:US
Practice Address - Phone:305-282-8136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-11
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11027568363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL121550200Medicaid