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General NPI Number Information
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NPI Number | 1689148306
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Entity Type | Individual
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Provider Name | VICTORIA CORRELL PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/15/2019
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Last Update Date | 05/19/2021
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Provider Practice Location Address
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Address Line | 4647 MANATEE AVE W
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City | BRADENTON
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State | FL
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Zip | 34209-3816
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Country | US
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Telephone | 941-745-5999
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Fax | 941-745-3555
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Provider Business Mailing Address
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Address Line | 367 S GULPH RD ATTN IPM CREDENTIALING
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-3121
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Country | US
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Telephone | 941-745-5999
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Fax | 941-745-3555
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9111971
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License Number State | FL
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