Provider Demographics
NPI:1003174798
Name:DENSON, VONCILLE YVETTE
Entity Type:Individual
Prefix:MS
First Name:VONCILLE
Middle Name:YVETTE
Last Name:DENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14894
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32238-1894
Mailing Address - Country:US
Mailing Address - Phone:904-437-4819
Mailing Address - Fax:888-879-3207
Practice Address - Street 1:1408 STATE ST W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-7639
Practice Address - Country:US
Practice Address - Phone:904-437-4819
Practice Address - Fax:888-879-3207
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL233178372500000X, 376J00000X, 372600000X
FL006475500372500000X, 372600000X, 376J00000X
3747A0650X, 374U00000X
FL3747P1801X
FL006475500-RES REHAB374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No372500000XNursing Service Related ProvidersChore Provider
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012239800Medicaid