MEDICARE: ROGELIO VILLANUEVA APRN

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	363LF0000X	Family Nurse Practitioner	APRN9433843	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306323886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGELIO VILLANUEVA APRN

Provider Business Mailing Address
First Line	:	9740 SW 40TH ST STE 6
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-4067
Country	:	US
Telephone Number	:	305-226-6265
Fax Number	:	305-226-0998

Provider Business Practice Location Address
First Line	:	9740 SW 40TH ST STE 6
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-4067
Country	:	US
Telephone Number	:	305-226-6265
Fax Number	:	305-226-0998

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

Provider Enumeration Date	:	07/26/2018
Last Update Date	:	06/13/2025

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