Provider Demographics
NPI:1962920611
Name:ANTONIO, VALERIE BLAIR (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:BLAIR
Last Name:ANTONIO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1860
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:1129 6TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4306
Practice Address - Country:US
Practice Address - Phone:682-885-6248
Practice Address - Fax:682-885-6249
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX876622363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX23318OtherTEXAS BOARD OF NURSING APRN PRESCRIPTIVE AUTHORIZATION