Provider Demographics
NPI:1528257482
Name:FOX, VALERIE AYLA (LMT)
Entity type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:AYLA
Last Name:FOX
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1758 RIVER BIRCH HOLW
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5535
Mailing Address - Country:US
Mailing Address - Phone:850-556-7857
Mailing Address - Fax:850-878-5242
Practice Address - Street 1:1304 E 6TH AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-6506
Practice Address - Country:US
Practice Address - Phone:850-556-7857
Practice Address - Fax:850-878-5242
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA7897174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC4009OtherBLUE CROSS BLUE SHIELD