Provider Demographics
NPI:1811567761
Name:VALENTINE, JACQUELYN ANITA (RN)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:ANITA
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2036 JOMIL CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-3053
Mailing Address - Country:US
Mailing Address - Phone:904-485-6810
Mailing Address - Fax:
Practice Address - Street 1:2036 JOMIL CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-3053
Practice Address - Country:US
Practice Address - Phone:904-485-6810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9383496163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse