Healthcare Provider Details

I. General information

NPI: 1649732306
Provider Name (Legal Business Name): DANIELLE VILLAFUERTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3533 S ALAMEDA ST
CORPUS CHRISTI TX
78411-1721
US

IV. Provider business mailing address

4302 CONGRESSIONAL DR
CORPUS CHRISTI TX
78413-2529
US

V. Phone/Fax

Practice location:
  • Phone: 361-694-5335
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAP141152
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: