Provider Demographics
NPI:1689802670
Name:VALENCIA, JENNY A (MD)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:A
Last Name:VALENCIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 W HILLSBORO BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4395
Mailing Address - Country:US
Mailing Address - Phone:954-794-1360
Mailing Address - Fax:954-794-1367
Practice Address - Street 1:5300 W HILLSBORO BLVD STE 110
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4395
Practice Address - Country:US
Practice Address - Phone:954-794-1360
Practice Address - Fax:954-794-1367
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104931208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9620OtherHOUSE PLYSICIAN LICENSE