Provider Demographics
NPI:1841710753
Name:TAGUE, VICTORIA ANNE (RN, MSN, FNP-BC)
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:ANNE
Last Name:TAGUE
Suffix:
Gender:F
Credentials:RN, MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 4TH AVE APT D3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3913
Mailing Address - Country:US
Mailing Address - Phone:727-709-1937
Mailing Address - Fax:
Practice Address - Street 1:7901 4TH AVENUE
Practice Address - Street 2:APT D3
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209
Practice Address - Country:US
Practice Address - Phone:727-709-1937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY341426363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily