Provider Demographics
NPI:1134443815
Name:HANCOCK, MAE ROSANNE VILLEGAS (PA-C)
Entity type:Individual
Prefix:
First Name:MAE ROSANNE
Middle Name:VILLEGAS
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MAE ROSANNE
Other - Middle Name:V
Other - Last Name:HANCOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:515 WEKIVA COMMONS CIR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-3645
Mailing Address - Country:US
Mailing Address - Phone:407-464-9516
Mailing Address - Fax:407-464-9519
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-265-5911
Practice Address - Fax:352-265-5606
Is Sole Proprietor?:No
Enumeration Date:2010-03-24
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110010729363A00000X
NC0010-15257363A00000X
FLPA9105391363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001947500Medicaid