Provider Demographics
NPI:1639644644
Name:VALENTIN, ALEXANDERIA (FNP)
Entity Type:Individual
Prefix:
First Name:ALEXANDERIA
Middle Name:
Last Name:VALENTIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 CADDIS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-8139
Mailing Address - Country:US
Mailing Address - Phone:843-496-7888
Mailing Address - Fax:
Practice Address - Street 1:1330 DUTCH FORK RD
Practice Address - Street 2:
Practice Address - City:BALLENTINE
Practice Address - State:SC
Practice Address - Zip Code:29002
Practice Address - Country:US
Practice Address - Phone:803-749-1666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22101363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily