Provider Demographics
NPI:1578178638
Name:VILLANUEVA, DOREEN MICHELE (DNP)
Entity Type:Individual
Prefix:DR
First Name:DOREEN
Middle Name:MICHELE
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20851 LAKE TALIA BLVD
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-3701
Mailing Address - Country:US
Mailing Address - Phone:813-205-1915
Mailing Address - Fax:
Practice Address - Street 1:20851 LAKE TALIA BLVD
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-3701
Practice Address - Country:US
Practice Address - Phone:813-205-1915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11012653363L00000X
FLF08201359207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine