Healthcare Provider Details

I. General information

NPI: 1265679328
Provider Name (Legal Business Name): LISA MARIE VALDEZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2009
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4251 SECRET SHOALS WAY
BUFORD GA
30518-8855
US

IV. Provider business mailing address

4251 SECRET SHOALS WAY
BUFORD GA
30518-8855
US

V. Phone/Fax

Practice location:
  • Phone: 407-619-0910
  • Fax: 407-619-0910
Mailing address:
  • Phone: 407-619-0910
  • Fax: 407-619-0910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN197799
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN197799
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: