Individual
MRS. NICOLE TOMKO VILLEGAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2801 JONES DR, LAREDO, TX 78045-8901
(956) 523-2619
Mailing address
2801 JONES DR, LAREDO, TX 78045-8901
(956) 523-2619
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
619339
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
142497004
—
TX
05
—
142497009
—
TX
01
—
85041U
BCBS
TX
01
—
P00191328
MEDICARE RAILROAD
TX
01
—
P00971759
MEDICARE RAILROAD
TX
Enumeration date
01/30/2006
Last updated
01/12/2012
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