Provider Demographics
NPI:1396258430
Name:VILLANUEVA, KRISTIE MARIE (RN)
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:MARIE
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 WILD FLOWER ST
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-8055
Mailing Address - Country:US
Mailing Address - Phone:321-890-2835
Mailing Address - Fax:
Practice Address - Street 1:750 WILD FLOWER ST
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-8055
Practice Address - Country:US
Practice Address - Phone:321-890-2835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-12
Last Update Date:2017-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9213102163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management