Healthcare Provider Details

I. General information

NPI: 1821489204
Provider Name (Legal Business Name): MARY JANE ALCANTARA VENZON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2015
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2304 ALOMA AVE STE 100
WINTER PARK FL
32792-3330
US

IV. Provider business mailing address

2304 ALOMA AVE STE 100
WINTER PARK FL
32792-3330
US

V. Phone/Fax

Practice location:
  • Phone: 407-679-9222
  • Fax: 407-679-9061
Mailing address:
  • Phone: 407-679-9222
  • Fax: 407-679-9061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN9404408
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberH119413
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: