Provider Demographics
NPI:1235918947
Name:IVY, VICTORIA BROOKE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:BROOKE
Last Name:IVY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:MCQUESTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:273 MEBANEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:TN
Mailing Address - Zip Code:38344-2910
Mailing Address - Country:US
Mailing Address - Phone:731-415-0364
Mailing Address - Fax:
Practice Address - Street 1:1894 CEDAR ST
Practice Address - Street 2:
Practice Address - City:MC KENZIE
Practice Address - State:TN
Practice Address - Zip Code:38201-2206
Practice Address - Country:US
Practice Address - Phone:731-207-6496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34621363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily