Provider Demographics
NPI:1346078128
Name:VALDEZ, MARY CARMEN (FNP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CARMEN
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14288 BENSBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-0442
Mailing Address - Country:US
Mailing Address - Phone:352-476-7147
Mailing Address - Fax:
Practice Address - Street 1:16348 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-8980
Practice Address - Country:US
Practice Address - Phone:352-476-7147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11034173363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily