Provider Demographics
NPI:1962016824
Name:BLANCO VALDES, LUCIA TATIANA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:LUCIA
Middle Name:TATIANA
Last Name:BLANCO VALDES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:6746 SW 115TH CT APT 202
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-4896
Mailing Address - Country:US
Mailing Address - Phone:786-333-3861
Mailing Address - Fax:
Practice Address - Street 1:900 PARK CENTRE BLVD STE 400A
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-5371
Practice Address - Country:US
Practice Address - Phone:305-912-8603
Practice Address - Fax:305-907-5343
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL11009013363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner