Provider Demographics
NPI:1700559770
Name:TARAVELLA, VICTORIA JANE (PA-C)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:JANE
Last Name:TARAVELLA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7809 JEFFERSON HWY STE D2
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1200
Mailing Address - Country:US
Mailing Address - Phone:225-767-4668
Mailing Address - Fax:225-360-3900
Practice Address - Street 1:7809 JEFFERSON HWY STE D2
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1200
Practice Address - Country:US
Practice Address - Phone:225-767-4668
Practice Address - Fax:225-360-3900
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA328191363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant