Provider Demographics
NPI:1194225193
Name:QUINTANILLA, JEREMY VILLANUEVA (RN)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:VILLANUEVA
Last Name:QUINTANILLA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2914 OLMOS CREEK DR APT 6202
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5452
Mailing Address - Country:US
Mailing Address - Phone:210-996-5114
Mailing Address - Fax:
Practice Address - Street 1:2914 OLMOS CREEK DR APT 6202
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-5452
Practice Address - Country:US
Practice Address - Phone:210-996-5114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX934957163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse