Provider Demographics
NPI:1104556778
Name:VILLEGAS, MARLIN (FNP-C)
Entity type:Individual
Prefix:
First Name:MARLIN
Middle Name:
Last Name:VILLEGAS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 HUNT DR
Mailing Address - Street 2:
Mailing Address - City:DENVER CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79323-3324
Mailing Address - Country:US
Mailing Address - Phone:580-649-1512
Mailing Address - Fax:
Practice Address - Street 1:415 N AVENUE F
Practice Address - Street 2:
Practice Address - City:DENVER CITY
Practice Address - State:TX
Practice Address - Zip Code:79323-2741
Practice Address - Country:US
Practice Address - Phone:806-592-9501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP1084156363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily