Provider Demographics
NPI:1306135694
Name:VILLADA, MARTHA PATRICIA (ACNP)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:PATRICIA
Last Name:VILLADA
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6124 W. PARKER RD.
Mailing Address - Street 2:530
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8140
Mailing Address - Country:US
Mailing Address - Phone:214-778-1075
Mailing Address - Fax:214-778-1237
Practice Address - Street 1:6124 W. PARKER RD.
Practice Address - Street 2:STE. 530
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8140
Practice Address - Country:US
Practice Address - Phone:214-778-1075
Practice Address - Fax:214-778-1237
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP111008363LA2100X
TX702907363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX702907OtherACNP LICENSE