Healthcare Provider Details

I. General information

NPI: 1992787824
Provider Name (Legal Business Name): MICHAEL SERVILLA CFNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 02/01/2026
Certification Date: 02/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13460 DESERT HILLS PL NE
ALBUQUERQUE NM
87111-3033
US

IV. Provider business mailing address

13460 DESERT HILLS PL NE
ALBUQUERQUE NM
87111-3033
US

V. Phone/Fax

Practice location:
  • Phone: 877-993-4321
  • Fax: 617-848-3198
Mailing address:
  • Phone: 505-926-1364
  • Fax: 617-848-3198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2025051325
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number329373
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP000487
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13255
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPRN-278341
License Number StateMT
# 6
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number244156
License Number StateAK
# 7
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number277005063
License Number StateIL
# 8
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPRN-5415
License Number StateHI
# 9
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAP70034977
License Number StateWA
# 10
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14246859-4405
License Number StateUT
# 11
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10049420
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: