Provider Demographics
NPI:1629229174
Name:VILLAR, JENNIFER AMELIA (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:AMELIA
Last Name:VILLAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 W GORE ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1141
Mailing Address - Country:US
Mailing Address - Phone:321-841-3303
Mailing Address - Fax:321-841-3305
Practice Address - Street 1:60 W GORE ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1141
Practice Address - Country:US
Practice Address - Phone:321-841-3303
Practice Address - Fax:321-841-3305
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1052852080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005975600Medicaid
FLME105285OtherMEDICAL LICENSE
FLME105285OtherMEDICAL LICENSE