Healthcare Provider Details

I. General information

NPI: 1013252410
Provider Name (Legal Business Name): JESSICA MARIE VALENTE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2012
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 POPE AVE NW
WINTER HAVEN FL
33881
US

IV. Provider business mailing address

1245 FLORAL WAY
APOPKA FL
32703-6619
US

V. Phone/Fax

Practice location:
  • Phone: 863-293-2144
  • Fax: 863-293-3732
Mailing address:
  • Phone: 813-205-5737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP9199204
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9199204
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: