Healthcare Provider Details

I. General information

NPI: 1669025904
Provider Name (Legal Business Name): NELSON FELIPE VILLAR APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10250 SW 56TH ST STE C101
MIAMI FL
33165-7065
US

IV. Provider business mailing address

10250 SW 56TH ST STE C101
MIAMI FL
33165-7065
US

V. Phone/Fax

Practice location:
  • Phone: 786-558-8901
  • Fax: 786-558-8917
Mailing address:
  • Phone: 786-558-8901
  • Fax: 786-558-8917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11003204
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: