Provider Demographics
NPI:1528597168
Name:MUNIZ, VALERIA NICOLE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:VALERIA
Middle Name:NICOLE
Last Name:MUNIZ
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 W TAMPA BAY BLVD APT F107
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-1324
Mailing Address - Country:US
Mailing Address - Phone:813-843-0642
Mailing Address - Fax:
Practice Address - Street 1:8318 N HABANA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2792
Practice Address - Country:US
Practice Address - Phone:813-667-2460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9110221363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant