Basic Information
| Provider Information | |||||||||
| NPI: | 1558089920 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VILLACHICA | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | JEANETTE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | APRN, FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4548 DAWN DR | ||||||||
| Address2: | |||||||||
| City: | MILTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325839292 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8505100847 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4910 N 12TH AVE | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325048972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504944600 | ||||||||
| FaxNumber: | 8504338940 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2022 | ||||||||
| LastUpdateDate: | 11/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 11021227 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.