Provider Demographics
NPI:1316619117
Name:VALENTIN, JACOB SAMUEL (RN)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:SAMUEL
Last Name:VALENTIN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3082 BRICKHOUSE CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-6859
Mailing Address - Country:US
Mailing Address - Phone:757-302-5663
Mailing Address - Fax:757-302-5458
Practice Address - Street 1:3082 BRICKHOUSE CT
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-6859
Practice Address - Country:US
Practice Address - Phone:757-302-5663
Practice Address - Fax:757-302-5458
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR33721163W00000X, 164W00000X
146L00000X, 246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy