Healthcare Provider Details

I. General information

NPI: 1497619084
Provider Name (Legal Business Name): JOEL ANTONIO VILLAMIZAR MSN, FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 N SHADELAND AVE STE 200
INDIANAPOLIS IN
46219-1764
US

IV. Provider business mailing address

2060 N SHADELAND AVE STE 200
INDIANAPOLIS IN
46219-1764
US

V. Phone/Fax

Practice location:
  • Phone: 317-635-3499
  • Fax: 317-635-4409
Mailing address:
  • Phone: 407-967-0313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28268783A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: