Provider Demographics
NPI:1528667169
Name:STA ANA, NOEMI VILLANUEVA (AGPCNP)
Entity type:Individual
Prefix:MS
First Name:NOEMI
Middle Name:VILLANUEVA
Last Name:STA ANA
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:MS
Other - First Name:NOEMI
Other - Middle Name:VILLANUEVA
Other - Last Name:STA. ANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGPCNP
Mailing Address - Street 1:189 ROUTE 100
Mailing Address - Street 2:
Mailing Address - City:SOMERS
Mailing Address - State:NY
Mailing Address - Zip Code:10589
Mailing Address - Country:US
Mailing Address - Phone:914-232-5101
Mailing Address - Fax:914-373-6497
Practice Address - Street 1:1738 NEWBRIDGE RD UNIT 1
Practice Address - Street 2:
Practice Address - City:NORTH BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-1657
Practice Address - Country:US
Practice Address - Phone:917-861-3374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-24
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309322363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty