Provider Demographics
NPI:1801406194
Name:OLIVA, VICTORIA (APRN)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:OLIVA
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18249 CLEAR LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33548-6436
Mailing Address - Country:US
Mailing Address - Phone:813-597-1681
Mailing Address - Fax:
Practice Address - Street 1:3330 S RIO GRANDE AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4847
Practice Address - Country:US
Practice Address - Phone:970-497-5979
Practice Address - Fax:970-497-5893
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11007791363LF0000X
COC-APN.0103824-C-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily