MEDICARE: JONESSA ANN VILLANUEVA M.D.

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	207R00000X	Internal Medicine Physician	36508	SC
2	207R00000X	Internal Medicine Physician	2020-03573	NC

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	:	1619256849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONESSA ANN VILLANUEVA M.D.

Provider Business Mailing Address
First Line	:	2021 N MYRTLE POINT BLVD STE 101
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-2224
Country	:	US
Telephone Number	:	843-366-2900
Fax Number	:	843-366-2450

Provider Business Practice Location Address
First Line	:	2021 N MYRTLE POINT BLVD STE 101
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-2224
Country	:	US
Telephone Number	:	843-366-2900
Fax Number	:

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

Provider Enumeration Date	:	08/05/2011
Last Update Date	:	07/23/2025

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