Provider Demographics
NPI:1033100474
Name:VALENZA, JULIE ALISON (PA)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ALISON
Last Name:VALENZA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 TAMIAMI TRL N STE 162
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5803
Mailing Address - Country:US
Mailing Address - Phone:239-316-3323
Mailing Address - Fax:239-235-0098
Practice Address - Street 1:15450 TAMIAMI TRL N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-6217
Practice Address - Country:US
Practice Address - Phone:239-316-3323
Practice Address - Fax:239-235-0098
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004363363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00007686OtherRR MEDICARE
FL114016100Medicaid
NY02346587Medicaid
S78462Medicare UPIN