Healthcare Provider Details

I. General information

NPI: 1346570603
Provider Name (Legal Business Name): MARIBEL VILLEGAS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2010
Last Update Date: 11/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 W TOWN PL
SAINT AUGUSTINE FL
32092-3101
US

IV. Provider business mailing address

255 OLD VILLAGE CENTER CIR UNIT #9206
SAINT AUGUSTINE FL
32084-5866
US

V. Phone/Fax

Practice location:
  • Phone: 904-940-1577
  • Fax:
Mailing address:
  • Phone: 954-649-7792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number9267529
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: