Provider Demographics
NPI:1376895425
Name:VILLACRESES, ANDRES G (APRN)
Entity Type:Individual
Prefix:
First Name:ANDRES
Middle Name:G
Last Name:VILLACRESES
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-424-2030
Mailing Address - Fax:239-343-4116
Practice Address - Street 1:507 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-2618
Practice Address - Country:US
Practice Address - Phone:239-424-2030
Practice Address - Fax:239-343-4116
Is Sole Proprietor?:No
Enumeration Date:2012-10-12
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9276156363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01366891OtherRR MEDICARE
FLP100420OtherFREEDOM HEALTH
FL9252937OtherAETNA
FLP1004200OtherFREEDOM
FLY0E6TOtherBCBS FL
FLP01111858OtherRAILROAD MCR
FLP944975OtherOPTIMUM
FL007273800Medicaid
FL1308583OtherCIGNA
FLY0E6TOtherBCBS
FL007273800Medicaid
FLY0E6TOtherBCBS