MEDICARE: LUCY VILLANUEVA PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11025640	FL

General Provider Information

NPI Number	:	1164127379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCY VILLANUEVA PMHNP

Provider Business Mailing Address
First Line	:	3043 AMBASSADOR AVE
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-4510
Country	:	US
Telephone Number	:	352-247-0078
Fax Number	:

Provider Business Practice Location Address
First Line	:	16425 SPRING HILL DR
Second Line	:
City	:	BROOKSVILLE
State	:	FL
Zip	:	34604-8167
Country	:	US
Telephone Number	:	352-797-3769
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2023
Last Update Date	:	11/20/2024

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