Individual
JACY VILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2623 S SEACREST BLVD, SUITE 216, BOYNTON BEACH, FL 33435-7501
(561) 742-0065
(561) 742-0105
Mailing address
2234 COLONIAL BLVD, ATTN: PAYER CONTRACTING & RELATIONS DEPT., FORT MYERS, FL 33907-1412
(239) 931-7342
(239) 931-7385
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
ME80441
FL
207RX0202X
Medical Oncology Physician
24551
NH
207RX0202X
Medical Oncology Physician
ME80441
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14392
DIMENSION
FL
01
—
279218
AVMED
FL
01
—
5753526
AETNA
FL
01
—
57987
BCBS
FL
01
—
8490121
CIGNA
FL
01
—
P01594402
RR MEDICARE
FL
01
—
P1035622
FREEDOM
FL
01
—
P971389
OPTIMUM
FL
Enumeration date
07/08/2005
Last updated
08/09/2023
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