Provider Demographics
NPI:1558940395
Name:VALERO, HERNANDO JR (APRN)
Entity Type:Individual
Prefix:
First Name:HERNANDO
Middle Name:
Last Name:VALERO
Suffix:JR
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 LANTERN HILL AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-2377
Mailing Address - Country:US
Mailing Address - Phone:813-952-6920
Mailing Address - Fax:
Practice Address - Street 1:2370 WALDEN WOODS DR STE A
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-7027
Practice Address - Country:US
Practice Address - Phone:813-659-9800
Practice Address - Fax:813-659-9807
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11012445163WP0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163WP0200XNursing Service ProvidersRegistered NursePediatricsGroup - Single Specialty