Provider Demographics
NPI:1013652445
Name:VILLANUEVA, PERLA ELNAR (APRN)
Entity type:Individual
Prefix:
First Name:PERLA
Middle Name:ELNAR
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13164 SW 142ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-8921
Mailing Address - Country:US
Mailing Address - Phone:305-972-1101
Mailing Address - Fax:
Practice Address - Street 1:13164 SW 142ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-8921
Practice Address - Country:US
Practice Address - Phone:305-972-1101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11018392363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty