Provider Demographics
NPI:1184393258
Name:VARGAS-VILLA, JEZLYN (APRN)
Entity type:Individual
Prefix:
First Name:JEZLYN
Middle Name:
Last Name:VARGAS-VILLA
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 1:2871 CLAYTON CROSSING WAY STE 1049
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-3426
Mailing Address - Country:US
Mailing Address - Phone:407-602-3916
Mailing Address - Fax:
Practice Address - Street 1:2871 CLAYTON CROSSING WAY STE 1049
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-3426
Practice Address - Country:US
Practice Address - Phone:407-602-3916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11015335363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily