Healthcare Provider Details

I. General information

NPI: 1598421596
Provider Name (Legal Business Name): RICHELLE CECELIA VALDEZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2021
Last Update Date: 11/14/2021
Certification Date: 11/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 S HABANA AVE STE 180
TAMPA FL
33609-4195
US

IV. Provider business mailing address

4401 14TH ST NE
SAINT PETERSBURG FL
33703-5331
US

V. Phone/Fax

Practice location:
  • Phone: 813-448-6550
  • Fax: 813-448-6511
Mailing address:
  • Phone: 813-417-2158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11016217
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: