Provider Demographics
NPI:1609932318
Name:VILLAFLOR-ZITOUNI, ANTONNETTE (PA C)
Entity Type:Individual
Prefix:
First Name:ANTONNETTE
Middle Name:
Last Name:VILLAFLOR-ZITOUNI
Suffix:
Gender:F
Credentials: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:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-5915
Mailing Address - Fax:757-446-5969
Practice Address - Street 1:721 FAIRFAX AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-2007
Practice Address - Country:US
Practice Address - Phone:757-446-5915
Practice Address - Fax:757-446-5969
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002435363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA-017OtherTRICARE/CHAMPUS
VAPAROtherMULTIPLAN
VAPAROtherUSA MANAGED CARE
VA10019320POtherSENTARA/OPTIMA
VA1609932318Medicaid
NC8101070Medicaid
VA10014991POtherSENTARA OPTIMA
VAPAROtherCORVEL/CORCARE
VA012735E30Medicare PIN
VAP00416322Medicare PIN
NC8101070Medicaid