Provider Demographics
NPI:1780213512
Name:VILLAMARIA, NICOLE MILLER (MD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MILLER
Last Name:VILLAMARIA
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 1:709 S BAGDAD ROAD
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-8799
Mailing Address - Country:US
Mailing Address - Phone:512-260-0101
Mailing Address - Fax:
Practice Address - Street 1:709 S BAGDAD ROAD
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-8799
Practice Address - Country:US
Practice Address - Phone:512-260-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10070700208000000X
TXU3597208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics