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General NPI Number Information
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NPI Number | 1396020426
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Entity Type | Individual
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Provider Name | VICTORIA JEAN VANACORE PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/20/2011
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Last Update Date | 01/21/2026
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Provider Practice Location Address
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Address Line | 790 W POPLAR AVE
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City | COLLIERVILLE
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State | TN
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Zip | 38017-2544
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Country | US
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Telephone | 901-853-9700
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Fax | 901-245-4244
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Provider Business Mailing Address
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Address Line | 790 W POPLAR AVE
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City | COLLIERVILLE
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State | TN
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Zip | 38017-2544
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Country | US
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Telephone | 901-853-9700
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Fax | 901-245-4244
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9106248
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 3386
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9106248
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License Number State | FL
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