Provider Demographics
NPI:1609974351
Name:VILLALTA, YESENIA D (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:YESENIA
Middle Name:D
Last Name:VILLALTA
Suffix:
Gender:F
Credentials:ARNP
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8175 NW 12TH ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1828
Mailing Address - Country:US
Mailing Address - Phone:786-845-0173
Mailing Address - Fax:305-845-0306
Practice Address - Street 1:8175 NW 12TH ST
Practice Address - Street 2:SUITE 306
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-1828
Practice Address - Country:US
Practice Address - Phone:786-845-0173
Practice Address - Fax:305-845-0306
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL3421002363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307046800Medicaid