Healthcare Provider Details

I. General information

NPI: 1568988665
Provider Name (Legal Business Name): JANCY ROENSA VICTORIA APN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANCY ROENSA TEJADA ACOSTA APN-C

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 RIVER AVE UNIT 3
LAKEWOOD NJ
08701-5288
US

IV. Provider business mailing address

685 RIVER AVE UNIT 3
LAKEWOOD NJ
08701-5288
US

V. Phone/Fax

Practice location:
  • Phone: 732-486-7373
  • Fax: 973-928-2716
Mailing address:
  • Phone: 732-486-7373
  • Fax: 732-282-7300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number311355
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: