Provider Demographics
NPI:1487661781
Name:VILLA, JOSE L JR (DNP, APRN, FNP, BC)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:L
Last Name:VILLA
Suffix:JR
Gender:M
Credentials:DNP, APRN, FNP, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7814 OAKDALE PARK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-5485
Mailing Address - Country:US
Mailing Address - Phone:210-859-2531
Mailing Address - Fax:210-595-1183
Practice Address - Street 1:311 FUTURE DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-3481
Practice Address - Country:US
Practice Address - Phone:210-595-1182
Practice Address - Fax:210-595-1183
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP111090363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176118104Medicaid
TX176118105OtherCSHCN