Healthcare Provider Details

I. General information

NPI: 1912581737
Provider Name (Legal Business Name): LILIA DENEB VENTO VALVERDE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3691 CLYDE MORRIS BLVD
PORT ORANGE FL
32129-2317
US

IV. Provider business mailing address

3691 CLYDE MORRIS BLVD
PORT ORANGE FL
32129-2317
US

V. Phone/Fax

Practice location:
  • Phone: 386-675-4411
  • Fax: 866-542-5859
Mailing address:
  • Phone: 386-675-4411
  • Fax: 866-542-5859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11015889
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number871769
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number26NJ01317600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: