MEDICARE: VICTORIA JEAN VANACORE PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	PA9106248	FL
2	363A00000X	Physician Assistant	3386	TN
3	363A00000X	Physician Assistant	PA9106248	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	P01584470	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1242841	OTHER	FL	WELLCARE
3	5359596	OTHER	FL	CIGNA
4	P1032516	OTHER	FL	FREEDOM
5	P968867	OTHER	FL	OPTIMUM
6	YJAAL	OTHER	FL	BCBS
7	9422829	OTHER	FL	AETNA
8	398528	OTHER	FL	AVMED

General Provider Information

NPI Number	:	1396020426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA JEAN VANACORE PA-C

Provider Business Mailing Address
First Line	:	790 W POPLAR AVE
Second Line	:
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-2544
Country	:	US
Telephone Number	:	901-853-9700
Fax Number	:	901-245-4244

Provider Business Practice Location Address
First Line	:	790 W POPLAR AVE
Second Line	:
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-2544
Country	:	US
Telephone Number	:	901-853-9700
Fax Number	:	901-245-4244

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2011
Last Update Date	:	01/21/2026

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