Provider Demographics
NPI:1053202275
Name:TINOCO VILLAMARIN, LUISA T (FNP)
Entity type:Individual
Prefix:MISS
First Name:LUISA
Middle Name:T
Last Name:TINOCO VILLAMARIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-2604
Mailing Address - Country:US
Mailing Address - Phone:862-452-8327
Mailing Address - Fax:
Practice Address - Street 1:690 N 5TH ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-2604
Practice Address - Country:US
Practice Address - Phone:862-452-8327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15367400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily