1184016453 NPI number — MRS. JANNELLE VICENS DNP, APRN, FNP-BC

Table of content: MRS. JANNELLE VICENS DNP, APRN, FNP-BC (NPI 1184016453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184016453 NPI number — MRS. JANNELLE VICENS DNP, APRN, FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VICENS
Provider First Name:
JANNELLE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DNP, APRN, FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HERNANDEZ
Provider Other First Name:
JANNELLE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
BSN, RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184016453
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 743144
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-3144
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-596-2000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8900 N KENDALL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33176-2118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-527-6000
Provider Business Practice Location Address Fax Number:
786-814-4283
Provider Enumeration Date:
02/24/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  APRN9394363 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: APRN9394363 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ARNP9394363 . This is a "ARNP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 689346 . This is a "RN LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 104180900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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