Provider Demographics
NPI:1063053072
Name:VILLA, BLAS EDWARD (AGACNP)
Entity type:Individual
Prefix:
First Name:BLAS
Middle Name:EDWARD
Last Name:VILLA
Suffix:
Gender:M
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7703 FLOYD CURL DRIVE MC 7885 PULMONARY DISEASES & CRIT
Mailing Address - Street 2:MEDICINE
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229
Mailing Address - Country:US
Mailing Address - Phone:325-226-2770
Mailing Address - Fax:
Practice Address - Street 1:2833 BABCOCK RD STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4894
Practice Address - Country:US
Practice Address - Phone:210-271-0606
Practice Address - Fax:210-853-2707
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142810363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care