Healthcare Provider Details

I. General information

NPI: 1659176758
Provider Name (Legal Business Name): DENNISE ANNE VICENCIO FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 S RAINBOW BLVD STE 17
LAS VEGAS NV
89146-2970
US

IV. Provider business mailing address

2120 HOYT AVE
LAS VEGAS NV
89104-3939
US

V. Phone/Fax

Practice location:
  • Phone: 702-473-9600
  • Fax:
Mailing address:
  • Phone: 702-358-9263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number833543
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11038102
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: