Provider Demographics
NPI:1316596489
Name:ISMAIL, VALERIE SMITH (APRN)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:SMITH
Last Name:ISMAIL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 SAPPHIRE LAKE DR UNIT 101
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-3445
Mailing Address - Country:US
Mailing Address - Phone:352-516-8991
Mailing Address - Fax:954-206-0526
Practice Address - Street 1:340 SAPPHIRE LAKE DR UNIT 101
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-3445
Practice Address - Country:US
Practice Address - Phone:352-516-8991
Practice Address - Fax:954-206-0526
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11003664363L00000X, 364SP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health