Provider Demographics
NPI:1851161152
Name:VALENCIA, ENRIQUE (NP)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:
Last Name:VALENCIA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 PINE ST STE 500
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-7530
Mailing Address - Country:US
Mailing Address - Phone:478-633-8682
Mailing Address - Fax:478-633-8698
Practice Address - Street 1:840 PINE ST STE 500
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-7530
Practice Address - Country:US
Practice Address - Phone:478-633-8682
Practice Address - Fax:478-633-8698
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN284102363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care