Provider Demographics
NPI:1760407654
Name:PAPPAS-VILLAFANE, VICTORIA (APN)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:PAPPAS-VILLAFANE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 STATE ROUTE 66 STE 5
Mailing Address - Street 2:PARKWAY 100
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-2625
Mailing Address - Country:US
Mailing Address - Phone:732-643-4350
Mailing Address - Fax:732-643-4398
Practice Address - Street 1:3535 STATE ROUTE 66 STE 5
Practice Address - Street 2:PARKWAY 100
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-2625
Practice Address - Country:US
Practice Address - Phone:732-643-4350
Practice Address - Fax:732-643-4398
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NC05307100363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP18253Medicare UPIN