Provider Demographics
NPI:1609202175
Name:VILLALONA, PORTIA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:PORTIA
Middle Name:
Last Name:VILLALONA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 UNIVERSITY PLZ STE 204
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-6211
Mailing Address - Country:US
Mailing Address - Phone:718-360-9370
Mailing Address - Fax:718-841-9438
Practice Address - Street 1:2 UNIVERSITY PLZ STE 204
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-6211
Practice Address - Country:US
Practice Address - Phone:718-360-9370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335821363LF0000X
NYF-335821363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1609202175Medicaid
NY1922334358Medicaid