Healthcare Provider Details

I. General information

NPI: 1407699580
Provider Name (Legal Business Name): AMY VILLEGAS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12670 WHITEHALL DR
FORT MYERS FL
33907-3619
US

IV. Provider business mailing address

12670 WHITEHALL DR
FORT MYERS FL
33907-3619
US

V. Phone/Fax

Practice location:
  • Phone: 239-936-3554
  • Fax:
Mailing address:
  • Phone: 239-936-3554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11043111
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: