Provider Demographics
NPI:1932460953
Name:VILAR, JEFFREY ROSS (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ROSS
Last Name:VILAR
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 N CENTRAL AVE STE 800
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2946
Mailing Address - Country:US
Mailing Address - Phone:602-421-1205
Mailing Address - Fax:
Practice Address - Street 1:3003 N CENTRAL AVE STE 800
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2946
Practice Address - Country:US
Practice Address - Phone:602-421-1205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4516363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner