Individual ProviderAlex VillavicencioNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133(260) 436-8686PECOS EnrollmentBased on the most recent information from CMS, provider Alex Villavicencio is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1053836882Provider TypeIndividualFull NameVillavicencio, AlexCredentialNP-CGenderMaleSole ProprietorNoEnumeration Date8/14/2017Last Updated7/21/2022Contact InformationPractice LocationPractice Address7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133Phone(260) 436-8686Fax(260) 436-8585Mailing LocationMailing Address7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133Phone(260) 436-8686Fax(260) 436-8585Provider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense71007374AIndiana