Healthcare Provider Details

I. General information

NPI: 1730987454
Provider Name (Legal Business Name): SELENA MLYNN VILLAGOMEZ RN,WCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9916 BALAYE RUN DR APT 203
TAMPA FL
33619-7655
US

IV. Provider business mailing address

9916 BALAYE RUN DR APT 203
TAMPA FL
33619-7655
US

V. Phone/Fax

Practice location:
  • Phone: 706-887-2292
  • Fax:
Mailing address:
  • Phone: 706-887-2292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberRN9522727
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: