Provider Demographics
NPI:1396502019
Name:VALDES NAVARRO, ISMARAY
Entity type:Individual
Prefix:
First Name:ISMARAY
Middle Name:
Last Name:VALDES NAVARRO
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 1:12545 SW 259TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-1207
Mailing Address - Country:US
Mailing Address - Phone:786-781-8602
Mailing Address - Fax:
Practice Address - Street 1:12545 SW 259TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-1207
Practice Address - Country:US
Practice Address - Phone:786-781-8602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11031276363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily