Provider Demographics
NPI:1851619886
Name:BLUE GRAHAM, VALENCIA D (ANP-BC)
Entity Type:Individual
Prefix:MRS
First Name:VALENCIA
Middle Name:D
Last Name:BLUE GRAHAM
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:MRS
Other - First Name:VALENCIA
Other - Middle Name:D
Other - Last Name:BLUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2051
Mailing Address - Country:US
Mailing Address - Phone:305-500-2000
Mailing Address - Fax:
Practice Address - Street 1:7200 NORMANDY BLVD STE 20
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-6271
Practice Address - Country:US
Practice Address - Phone:904-378-8520
Practice Address - Fax:904-378-8570
Is Sole Proprietor?:No
Enumeration Date:2010-05-14
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLANP9255707363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health