Healthcare Provider Details

I. General information

NPI: 1114897832
Provider Name (Legal Business Name): TAMARA BLANCA VILLIER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 BROADWAY STE 2128
NEW YORK NY
10018-9228
US

IV. Provider business mailing address

1412 BROADWAY STE 2128
NEW YORK NY
10018-9228
US

V. Phone/Fax

Practice location:
  • Phone: 718-615-0049
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number865941
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: