Provider Demographics
NPI:1659641595
Name:VALERON, AGUSTIN (ARNP)
Entity Type:Individual
Prefix:
First Name:AGUSTIN
Middle Name:
Last Name:VALERON
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5940 SW 153RD CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-2570
Mailing Address - Country:US
Mailing Address - Phone:786-443-8535
Mailing Address - Fax:
Practice Address - Street 1:5940 SW 153RD CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-2570
Practice Address - Country:US
Practice Address - Phone:786-443-8535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9357992363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL09237OtherCERTIFIED SURGICAL ASSISTANT