Provider Demographics
NPI:1598421596
Name:VALDEZ, RICHELLE CECELIA (FNP-C)
Entity Type:Individual
Prefix:
First Name:RICHELLE
Middle Name:CECELIA
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 14TH ST NE
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-5331
Mailing Address - Country:US
Mailing Address - Phone:813-417-2158
Mailing Address - Fax:
Practice Address - Street 1:508 S HABANA AVE STE 180
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4195
Practice Address - Country:US
Practice Address - Phone:813-448-6550
Practice Address - Fax:813-448-6511
Is Sole Proprietor?:No
Enumeration Date:2021-11-14
Last Update Date:2021-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11016217363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily