Provider Demographics
NPI:1619256849
Name:VILLANUEVA, JONESSA ANN (MD)
Entity Type:Individual
Prefix:
First Name:JONESSA ANN
Middle Name:
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JONESSA ANN
Other - Middle Name:
Other - Last Name:ATIENZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3350 SW 148TH AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-3259
Mailing Address - Country:US
Mailing Address - Phone:800-400-6354
Mailing Address - Fax:
Practice Address - Street 1:3350 SW 148TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-3259
Practice Address - Country:US
Practice Address - Phone:800-400-6354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-05
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2020-03573207R00000X
SC36508207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC365081Medicaid