Healthcare Provider Details

I. General information

NPI: 1245596089
Provider Name (Legal Business Name): PENNY ANN VILLELLA RNFA, CNOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 04/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 SE 1ST AVE SUITE 101
OCALA FL
34471-0408
US

IV. Provider business mailing address

2220 SE 15TH ST
OCALA FL
34471-2643
US

V. Phone/Fax

Practice location:
  • Phone: 352-690-6300
  • Fax:
Mailing address:
  • Phone: 352-629-2934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number2519822
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: