Provider Demographics
NPI:1053821314
Name:VILLARREAL, VENISA (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:VENISA
Middle Name:
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1449 W DURANTA AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TX
Mailing Address - Zip Code:78516-2328
Mailing Address - Country:US
Mailing Address - Phone:956-283-0566
Mailing Address - Fax:
Practice Address - Street 1:1449 W DURANTA AVE STE 3
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:TX
Practice Address - Zip Code:78516-2328
Practice Address - Country:US
Practice Address - Phone:956-283-0566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135153363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics