Provider Demographics
NPI:1336762657
Name:VILLANUEVA-PENAFLOR, JACQUELINE
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:VILLANUEVA-PENAFLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JACQUELINE
Other - Middle Name:VILLANUEVA
Other - Last Name:PENAFLOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7121 S PADRE ISLAND DR STE 302
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-4941
Mailing Address - Country:US
Mailing Address - Phone:361-851-5000
Mailing Address - Fax:
Practice Address - Street 1:7121 S PADRE ISLAND DR STE 302
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4941
Practice Address - Country:US
Practice Address - Phone:361-851-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-20
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143562363LX0001X, 363LF0000X
TX675661163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy