Provider Demographics
NPI:1093991309
Name:VALENTINE, GLENDA ELAINE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:GLENDA
Middle Name:ELAINE
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 822
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32348-0822
Mailing Address - Country:US
Mailing Address - Phone:850-584-2713
Mailing Address - Fax:
Practice Address - Street 1:599 E US HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32347-3537
Practice Address - Country:US
Practice Address - Phone:850-584-4011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA52083172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker