Provider Demographics
NPI:1982465811
Name:DEFLORIO, VICTORIA ANN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ANN
Last Name:DEFLORIO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19000 ST JOES PKWY
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1339
Mailing Address - Country:US
Mailing Address - Phone:734-213-3685
Mailing Address - Fax:
Practice Address - Street 1:32949 MYRNA DR
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-2913
Practice Address - Country:US
Practice Address - Phone:734-417-2154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704210175363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner