=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518091313
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NIKKI ANDREW VILLONA MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2007
-----------------------------------------------------
Last Update Date | 11/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 502 W HIGHLAND BLVD
-----------------------------------------------------
City | INVERNESS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34452-4720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-726-1551
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 PIPER LN APT 103
-----------------------------------------------------
City | PROSPECT HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60070-1848
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-520-3567
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 39090
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------