Provider Demographics
NPI:1740050236
Name:VILLANUEVA, LUIS HILARIO (APRN)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:HILARIO
Last Name:VILLANUEVA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:LUIS
Other - Middle Name:HILARIO
Other - Last Name:VILLANUEVA PONTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:7000 SW 97TH AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-1492
Mailing Address - Country:US
Mailing Address - Phone:305-667-7220
Mailing Address - Fax:305-667-6607
Practice Address - Street 1:7000 SW 97TH AVE STE 208
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-1492
Practice Address - Country:US
Practice Address - Phone:305-667-7220
Practice Address - Fax:305-667-6607
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11030257363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty