Basic Information
| Provider Information | |||||||||
| NPI: | 1083264386 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VALDEZ | ||||||||
| FirstName: | CARMEN | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7846 BRISTOL PARK DR | ||||||||
| Address2: | |||||||||
| City: | APOLLO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335721520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043059136 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6901 SIMMONS LOOP | ||||||||
| Address2: | |||||||||
| City: | RIVERVIEW | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335789498 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8133028000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2019 | ||||||||
| LastUpdateDate: | 09/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 11003208 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.