Healthcare Provider Details

I. General information

NPI: 1073159299
Provider Name (Legal Business Name): VALERIE VANCE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2019
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7560 RED BUG LAKE RD STE 1070
OVIEDO FL
32765-6591
US

IV. Provider business mailing address

460 E 3RD ST
CHULUOTA FL
32766-8571
US

V. Phone/Fax

Practice location:
  • Phone: 407-366-4040
  • Fax:
Mailing address:
  • Phone: 407-341-3439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number11001764
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: