Provider Demographics
NPI:1487114328
Name:VALDES, BRIANNA BIELSKI
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:BIELSKI
Last Name:VALDES
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 1:13330 USF LAUREL DR FL 5
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-6601
Mailing Address - Country:US
Mailing Address - Phone:813-821-8014
Mailing Address - Fax:813-974-7550
Practice Address - Street 1:13330 USF LAUREL DR FL 5
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-6601
Practice Address - Country:US
Practice Address - Phone:813-821-8014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME161626207R00000X, 207R00000X
IL036160086207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL118237300Medicaid
FL9D7FMOtherBCBS