Provider Demographics
NPI:1588250591
Name:VILLANUEVA, ROSETTE AILEEN (APRN)
Entity type:Individual
Prefix:
First Name:ROSETTE
Middle Name:AILEEN
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4898 DEEDER CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-4209
Mailing Address - Country:US
Mailing Address - Phone:904-962-2708
Mailing Address - Fax:
Practice Address - Street 1:6555 CHESTER AVE STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2279
Practice Address - Country:US
Practice Address - Phone:904-265-8209
Practice Address - Fax:045-503-3577
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11010459363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily