Provider Demographics
NPI:1952479008
Name:VILLICANA, PATRICK
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:
Last Name:VILLICANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 SE 8TH TER STE 200
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-3213
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:350 NW 84TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1859
Practice Address - Country:US
Practice Address - Phone:954-474-2929
Practice Address - Fax:954-474-9708
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN7728208800000X
FLME105141208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9763431OtherAETNA
FLQMP000003918664OtherMOLINA
FL336048OtherAVMED
FLPRL00000274175OtherPREFERRED MEDICAL PLAN
FLP983677OtherFREEDOM HEALTH
FL146WMOtherBCBS FL
FL4465503OtherCIGNA
FL12391OtherDIMENSIONS HEALTH
FLF00314331603OtherUNITED HEALTHCARE
FLP943004OtherOPTIMUM
FLPRL00000274175OtherPREFERRED MEDICAL PLAN