1356618904 NPI number — REGINA VILLANUEVA ROBERTSON APRN, AGPCNP-C

Table of content: REGINA VILLANUEVA ROBERTSON APRN, AGPCNP-C (NPI 1356618904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356618904 NPI number — REGINA VILLANUEVA ROBERTSON APRN, AGPCNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERTSON
Provider First Name:
REGINA
Provider Middle Name:
VILLANUEVA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN, AGPCNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356618904
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
06/27/2019
NPI Reactivation Date:
05/19/2026

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1121 BRIARCREST DR
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
BRYAN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77802-2500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
979-450-8781
Provider Business Mailing Address Fax Number:
979-202-6760

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1121 BRIARCREST DR
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
BRYAN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77802-2500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
979-450-8781
Provider Business Practice Location Address Fax Number:
979-202-6760
Provider Enumeration Date:
11/28/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  1216702 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1216702 . This is a "AGPCNP-C" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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