Provider Demographics
NPI:1104075092
Name:SERPICO, VICTORIA (APRN)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:SERPICO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 CIRCLE OF HOPE DR RM 6500
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84112-5500
Mailing Address - Country:US
Mailing Address - Phone:801-581-2431
Mailing Address - Fax:
Practice Address - Street 1:1950 CIRCLE OF HOPE
Practice Address - Street 2:SUITE NUMBER 6500
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84112
Practice Address - Country:US
Practice Address - Phone:801-581-2431
Practice Address - Fax:801-585-2984
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4946810-4405284300000X, 363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No284300000XHospitalsSpecial Hospital
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily