Healthcare Provider Details

I. General information

NPI: 1174577639
Provider Name (Legal Business Name): VALERIE E TAVARES-CARTER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 SE TIFFANY AVE
PORT ST. LUCIE FL
34952
US

IV. Provider business mailing address

1613 HARRISON PKWY STE 200
SUNRISE FL
33323-2853
US

V. Phone/Fax

Practice location:
  • Phone: 772-335-2471
  • Fax: 772-335-2497
Mailing address:
  • Phone: 954-838-2371
  • Fax: 954-851-1746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN9181223
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: