Provider Demographics
NPI:1083329080
Name:VILLARSON, FLORAINE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:FLORAINE
Middle Name:
Last Name:VILLARSON
Suffix:
Gender:
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 PERSIMMON DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-9071
Mailing Address - Country:US
Mailing Address - Phone:904-229-1290
Mailing Address - Fax:
Practice Address - Street 1:1113 PERSIMMON DR
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-9071
Practice Address - Country:US
Practice Address - Phone:904-229-1290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343900000X
FL11038425363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)