Provider Demographics
NPI:1568988665
Name:VICTORIA, JANCY ROENSA (APN-C)
Entity Type:Individual
Prefix:MRS
First Name:JANCY
Middle Name:ROENSA
Last Name:VICTORIA
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:JANCY
Other - Middle Name:ROENSA
Other - Last Name:TEJADA ACOSTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN-C
Mailing Address - Street 1:685 RIVER AVE UNIT 3
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5288
Mailing Address - Country:US
Mailing Address - Phone:732-486-7373
Mailing Address - Fax:732-282-7300
Practice Address - Street 1:685 RIVER AVE UNIT 3
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5288
Practice Address - Country:US
Practice Address - Phone:732-486-7373
Practice Address - Fax:973-928-2716
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311355363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY311355OtherADVANCED PRACTICE NURSE
NJP00792400OtherCDS REGISTRATION NUMBER
NJ26NR16892800OtherREGISTERED PROF. NURSE
NJ26NJ00734300OtherADVANCED PRACTICE NURSE