Healthcare Provider Details

I. General information

NPI: 1306135694
Provider Name (Legal Business Name): MARTHA PATRICIA VILLADA ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 10/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6124 W. PARKER RD. STE. 530
PLANO TX
75093-8140
US

IV. Provider business mailing address

6124 W. PARKER RD. 530
PLANO TX
75093-8140
US

V. Phone/Fax

Practice location:
  • Phone: 214-778-1075
  • Fax: 214-778-1237
Mailing address:
  • Phone: 214-778-1075
  • Fax: 214-778-1237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP111008
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number702907
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: