Provider Demographics
NPI:1396309928
Name:PLASENCIA, VICTORIA JEAN (LPN)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:JEAN
Last Name:PLASENCIA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:VICTORIA
Other - Middle Name:JEAN
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19476 N COQUINA WAY
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33332-2419
Mailing Address - Country:US
Mailing Address - Phone:954-822-8505
Mailing Address - Fax:
Practice Address - Street 1:19476 N COQUINA WAY
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33332-2419
Practice Address - Country:US
Practice Address - Phone:954-822-8505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5162729164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse