Provider Demographics
NPI:1053012021
Name:CROSBY, VICTORIA L (NP)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:L
Last Name:CROSBY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8245 LAKESHORE TRAIL WEST DR APT 2323
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-4709
Mailing Address - Country:US
Mailing Address - Phone:765-274-7134
Mailing Address - Fax:
Practice Address - Street 1:8245 LAKESHORE TRAIL WEST DR APT 2323
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-4709
Practice Address - Country:US
Practice Address - Phone:765-274-7134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28246205A363LF0000X
IN71014709A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300085124Medicaid