Provider Demographics
NPI:1861511750
Name:DORN, VALERIE RUTH ANNE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:RUTH ANNE
Last Name:DORN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:2227 US HIGHWAY 27 S
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-4936
Practice Address - Country:US
Practice Address - Phone:863-202-8100
Practice Address - Fax:863-202-8099
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9180863174400000X
FLARNP 9180863363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLKO044OtherMEDICARE
FLO8PTOOtherBCBS
FL016637828Medicaid