Provider Demographics
NPI:1730987454
Name:VILLAGOMEZ, SELENA MLYNN (RN,WCC)
Entity type:Individual
Prefix:
First Name:SELENA
Middle Name:MLYNN
Last Name:VILLAGOMEZ
Suffix:
Gender:F
Credentials:RN,WCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9916 BALAYE RUN DR APT 203
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-7655
Mailing Address - Country:US
Mailing Address - Phone:706-887-2292
Mailing Address - Fax:
Practice Address - Street 1:9916 BALAYE RUN DR APT 203
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-7655
Practice Address - Country:US
Practice Address - Phone:706-887-2292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9522727163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care