Provider Demographics
NPI:1285213900
Name:VILLAFUERTE, BIANCA RHEA BRIONES (MMS, PA-C)
Entity Type:Individual
Prefix:MISS
First Name:BIANCA RHEA
Middle Name:BRIONES
Last Name:VILLAFUERTE
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 SW 130TH TER
Mailing Address - Street 2:
Mailing Address - City:ARCHER
Mailing Address - State:FL
Mailing Address - Zip Code:32618-2123
Mailing Address - Country:US
Mailing Address - Phone:352-870-9551
Mailing Address - Fax:
Practice Address - Street 1:2125 SE 16TH PL
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-4703
Practice Address - Country:US
Practice Address - Phone:239-458-1131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9114039207N00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207N00000XAllopathic & Osteopathic PhysiciansDermatology