Provider Demographics
NPI:1841653953
Name:VALLE, PAMELA SUE (FNP-BC, PRACTITIONER)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUE
Last Name:VALLE
Suffix:
Gender:F
Credentials:FNP-BC, PRACTITIONER
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:SUE
Other - Last Name:VALLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE PRACTITIONER,
Mailing Address - Street 1:4181 SW HIGH MEADOWS AVE
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-3725
Mailing Address - Country:US
Mailing Address - Phone:772-221-7620
Mailing Address - Fax:772-221-9903
Practice Address - Street 1:655 N MILITARY TRL
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-1305
Practice Address - Country:US
Practice Address - Phone:561-686-0120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9351920363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily