Healthcare Provider Details

I. General information

NPI: 1255173134
Provider Name (Legal Business Name): VICTORIA MICHELLE ANGEL APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 WILLOW CREEK RD STE C
PRESCOTT AZ
86301-1645
US

IV. Provider business mailing address

1000 WILLOW CREEK RD STE C
PRESCOTT AZ
86301-1645
US

V. Phone/Fax

Practice location:
  • Phone: 928-362-0577
  • Fax: 928-916-5441
Mailing address:
  • Phone: 928-362-0577
  • Fax: 928-916-5441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number221248
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number221248
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number221248
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number221248
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: