Provider Demographics
NPI:1033413125
Name:VILLAREAL- ARGENTE, VIDETTE (FNP-C)
Entity Type:Individual
Prefix:
First Name:VIDETTE
Middle Name:
Last Name:VILLAREAL- ARGENTE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N 12TH ST STE 407
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2842
Mailing Address - Country:US
Mailing Address - Phone:602-839-7393
Mailing Address - Fax:602-839-7661
Practice Address - Street 1:1300 N 12TH ST STE 407
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2842
Practice Address - Country:US
Practice Address - Phone:602-839-7393
Practice Address - Fax:602-839-7661
Is Sole Proprietor?:No
Enumeration Date:2011-01-04
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN112199363LF0000X
AZAP3891363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ585910Medicaid
Z143095Medicare PIN