Provider Demographics
NPI:1063960284
Name:VINSON-ANDERSON, VALERIE MICHELLE
Entity type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:MICHELLE
Last Name:VINSON-ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12263 HARTS RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-3795
Mailing Address - Country:US
Mailing Address - Phone:904-763-3922
Mailing Address - Fax:
Practice Address - Street 1:12263 HARTS RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-3795
Practice Address - Country:US
Practice Address - Phone:904-252-2644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-16
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care