Provider Demographics
NPI:1235710351
Name:DAVIS, VALENCIA
Entity Type:Individual
Prefix:
First Name:VALENCIA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
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 848
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33575-0848
Mailing Address - Country:US
Mailing Address - Phone:813-369-1303
Mailing Address - Fax:
Practice Address - Street 1:2228 ROANOKE SPRINGS DR
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-6314
Practice Address - Country:US
Practice Address - Phone:813-369-1303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No251E00000XAgenciesHome Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service