Provider Demographics
NPI:1265679328
Name:VALDEZ, LISA MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3138 FARMSTEAD CT
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-4273
Mailing Address - Country:US
Mailing Address - Phone:407-619-0910
Mailing Address - Fax:
Practice Address - Street 1:3138 FARMSTEAD CT
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-4273
Practice Address - Country:US
Practice Address - Phone:407-619-0910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN197799363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily