Provider Demographics
NPI:1083450662
Name:VILLAVICENCIO, SILVIA (APRN)
Entity type:Individual
Prefix:
First Name:SILVIA
Middle Name:
Last Name:VILLAVICENCIO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10540 SW 30TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2762
Mailing Address - Country:US
Mailing Address - Phone:786-262-5438
Mailing Address - Fax:
Practice Address - Street 1:9350 SW 72ND ST STE 116
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3245
Practice Address - Country:US
Practice Address - Phone:305-200-5015
Practice Address - Fax:786-703-7011
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11033725163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health