Provider Demographics
NPI:1447666060
Name:VILLAVICENCIO, ROSA ANGELICA (FNP BC)
Entity type:Individual
Prefix:
First Name:ROSA ANGELICA
Middle Name:
Last Name:VILLAVICENCIO
Suffix:
Gender:F
Credentials:FNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 S HIGHLAND AVE APT 1B
Mailing Address - Street 2:
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-5842
Mailing Address - Country:US
Mailing Address - Phone:914-433-2542
Mailing Address - Fax:
Practice Address - Street 1:119 S HIGHLAND AVE APT 1B
Practice Address - Street 2:
Practice Address - City:OSSINING
Practice Address - State:NY
Practice Address - Zip Code:10562-5842
Practice Address - Country:US
Practice Address - Phone:914-433-2542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338915363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily