Healthcare Provider Details

I. General information

NPI: 1841340429
Provider Name (Legal Business Name): CARMEN MERCEDES VILLANUEVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 SE MAGNOLIA EXT
OCALA FL
34471-4443
US

IV. Provider business mailing address

PO BOX 6200
OCALA FL
34478-6200
US

V. Phone/Fax

Practice location:
  • Phone: 352-351-7200
  • Fax:
Mailing address:
  • Phone: 352-671-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number14157
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number103277
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number14157
License Number StatePR
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME134615
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101283919
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: