Provider Demographics
NPI:1578665345
Name:VALDES, TERESA MARIE (ARNP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:VALDES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6726 HANLEY RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-4739
Mailing Address - Country:US
Mailing Address - Phone:813-284-7903
Mailing Address - Fax:
Practice Address - Street 1:6726 HANLEY RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-4739
Practice Address - Country:US
Practice Address - Phone:813-284-7903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1855972363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL212027OtherAMERIGROUP
Y6136OtherBLUE CROSS BLUE SHIELD