Healthcare Provider Details

I. General information

NPI: 1316559388
Provider Name (Legal Business Name): VIVIAN VALENZUELA BLANCO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2879 N NARCOOSSEE RD
SAINT CLOUD FL
34771-8781
US

IV. Provider business mailing address

2879 N NARCOOSSEE RD
SAINT CLOUD FL
34771-8781
US

V. Phone/Fax

Practice location:
  • Phone: 689-588-5588
  • Fax:
Mailing address:
  • Phone: 689-588-5588
  • Fax: 888-355-6706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11008719
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: