Provider Demographics
NPI:1972935468
Name:DE VILLIERS, ALLISON ANN (CNS)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:ANN
Last Name:DE VILLIERS
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10518 VIA DE ROBINA CT
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6334
Mailing Address - Country:US
Mailing Address - Phone:330-603-6369
Mailing Address - Fax:
Practice Address - Street 1:10518 VIA DE ROBINA CT
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6334
Practice Address - Country:US
Practice Address - Phone:330-603-6369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA14881-NS364SX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncology