Provider Demographics
NPI:1164985073
Name:VILLANUEVA, FARAH EMBOY (FNP)
Entity Type:Individual
Prefix:
First Name:FARAH
Middle Name:EMBOY
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22167 WESTHEIMER PKWY STE 105
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-8301
Mailing Address - Country:US
Mailing Address - Phone:281-305-0735
Mailing Address - Fax:
Practice Address - Street 1:22167 WESTHEIMER PKWY STE 105
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-8301
Practice Address - Country:US
Practice Address - Phone:281-305-0735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily