Provider Demographics
NPI:1982465811
Name:DEFLORIO, VICTORIA ANN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ANN
Last Name:DEFLORIO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4568 W WALTON BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-4900
Mailing Address - Country:US
Mailing Address - Phone:855-466-3631
Mailing Address - Fax:833-973-4493
Practice Address - Street 1:4568 W WALTON BLVD STE D
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-4900
Practice Address - Country:US
Practice Address - Phone:855-466-3631
Practice Address - Fax:833-973-4493
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704210175363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner