Provider Demographics
NPI:1578922423
Name:VALDUEZA, SUSSETE (ARNP)
Entity Type:Individual
Prefix:
First Name:SUSSETE
Middle Name:
Last Name:VALDUEZA
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 1:220 9TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT JOE
Mailing Address - State:FL
Mailing Address - Zip Code:32456-1924
Mailing Address - Country:US
Mailing Address - Phone:850-229-8244
Mailing Address - Fax:850-229-1042
Practice Address - Street 1:235 CENTER ST
Practice Address - Street 2:
Practice Address - City:APALACHICOLA
Practice Address - State:FL
Practice Address - Zip Code:32320-1854
Practice Address - Country:US
Practice Address - Phone:786-547-9182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-22
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2892272363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily