Provider Demographics
NPI:1548294507
Name:VILLA, OLGA NANCY (PHSICIAN ASSISTANT)
Entity type:Individual
Prefix:MS
First Name:OLGA NANCY
Middle Name:
Last Name:VILLA
Suffix:
Gender:F
Credentials:PHSICIAN ASSISTANT
Other - Prefix:MS
Other - First Name:OLGA NANCY
Other - Middle Name:
Other - Last Name:VILLA- RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICIAN ASSISTANT
Mailing Address - Street 1:4800 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4701
Mailing Address - Country:US
Mailing Address - Phone:602-955-1000
Mailing Address - Fax:602-508-4874
Practice Address - Street 1:9425 W BELL RD
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-1300
Practice Address - Country:US
Practice Address - Phone:602-955-1000
Practice Address - Fax:602-508-4874
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3219363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ500660Medicaid