Provider Demographics
NPI:1689488116
Name:ALCANTARA, JELLY ANN RAMIREZ
Entity type:Individual
Prefix:
First Name:JELLY ANN
Middle Name:RAMIREZ
Last Name:ALCANTARA
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 1:1016 ROWLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23324-1152
Mailing Address - Country:US
Mailing Address - Phone:757-389-6289
Mailing Address - Fax:
Practice Address - Street 1:1016 ROWLAND AVE
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23324-1152
Practice Address - Country:US
Practice Address - Phone:757-389-6289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001271232163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care