Provider Demographics
NPI:1265401046
Name:VANFOSSEN, JANICE DIANNE (CNM)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:DIANNE
Last Name:VANFOSSEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 OAK COMMONS BLVD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4198
Mailing Address - Country:US
Mailing Address - Phone:407-846-7200
Mailing Address - Fax:407-846-3989
Practice Address - Street 1:610 OAK COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4198
Practice Address - Country:US
Practice Address - Phone:407-846-7200
Practice Address - Fax:407-846-3989
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9219070176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ63958Medicare UPIN