Provider Demographics
NPI:1124752308
Name:VALCIMOND, JYNA SANON (ARNP)
Entity type:Individual
Prefix:MRS
First Name:JYNA
Middle Name:SANON
Last Name:VALCIMOND
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JYNA
Other - Middle Name:SANON
Other - Last Name:VALCIMOND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:4551 NW 70TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4043
Mailing Address - Country:US
Mailing Address - Phone:754-368-1742
Mailing Address - Fax:
Practice Address - Street 1:4551 NW 70TH AVE
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-4043
Practice Address - Country:US
Practice Address - Phone:754-368-1742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11020612363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily