Provider Demographics
NPI:1336979715
Name:VALDES, GRETCHEN ALEXIS (PA)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:ALEXIS
Last Name:VALDES
Suffix:
Gender:
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:1141 SW 25TH ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-4189
Mailing Address - Country:US
Mailing Address - Phone:786-492-9767
Mailing Address - Fax:
Practice Address - Street 1:8931 COLONIAL CENTER DR STE 400
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-7809
Practice Address - Country:US
Practice Address - Phone:239-334-6626
Practice Address - Fax:239-334-0404
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9119882363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant