Provider Demographics
NPI:1679167373
Name:VILLARES, GRISELL (APRN)
Entity Type:Individual
Prefix:MRS
First Name:GRISELL
Middle Name:
Last Name:VILLARES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:GRISELL
Other - Middle Name:
Other - Last Name:VILLARES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARPN
Mailing Address - Street 1:4578 W 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3325
Mailing Address - Country:US
Mailing Address - Phone:305-828-1989
Mailing Address - Fax:
Practice Address - Street 1:7950 NW 2ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-8017
Practice Address - Country:US
Practice Address - Phone:305-642-5366
Practice Address - Fax:305-631-3851
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11011660363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily