Healthcare Provider Details

I. General information

NPI: 1245336650
Provider Name (Legal Business Name): VALERIE NUMSSEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 08/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 NW 64TH TER SUITE B
GAINESVILLE FL
32605-4228
US

IV. Provider business mailing address

1131 NW 64TH TER SUITE B
GAINESVILLE FL
32605-4228
US

V. Phone/Fax

Practice location:
  • Phone: 352-332-9940
  • Fax: 352-332-9939
Mailing address:
  • Phone: 352-332-9940
  • Fax: 352-332-9939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME78807
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: