Provider Demographics
NPI:1811741481
Name:VILMAR, ROUDY
Entity type:Individual
Prefix:
First Name:ROUDY
Middle Name:
Last Name:VILMAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5280 NW 55TH BLVD APT 101
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3783
Mailing Address - Country:US
Mailing Address - Phone:954-234-5734
Mailing Address - Fax:
Practice Address - Street 1:5280 NW 55TH BLVD APT 101
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-3783
Practice Address - Country:US
Practice Address - Phone:954-234-5734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9495909163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse