Healthcare Provider Details

I. General information

NPI: 1356618904
Provider Name (Legal Business Name): REGINA VILLANUEVA ROBERTSON APRN, AGPCNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date: 06/27/2019
Reactivation Date: 05/19/2026

III. Provider practice location address

1121 BRIARCREST DR STE 100
BRYAN TX
77802-2500
US

IV. Provider business mailing address

1121 BRIARCREST DR STE 100
BRYAN TX
77802-2500
US

V. Phone/Fax

Practice location:
  • Phone: 979-450-8781
  • Fax: 979-202-6760
Mailing address:
  • Phone: 979-450-8781
  • Fax: 979-202-6760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1216702
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: