Provider Demographics
NPI:1245596089
Name:VILLELLA, PENNY ANN (RNFA, CNOR)
Entity Type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:ANN
Last Name:VILLELLA
Suffix:
Gender:F
Credentials:RNFA, CNOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 SE 15TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-2643
Mailing Address - Country:US
Mailing Address - Phone:352-629-2934
Mailing Address - Fax:
Practice Address - Street 1:2801 SE 1ST AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0408
Practice Address - Country:US
Practice Address - Phone:352-690-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2519822163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant