Provider Demographics
NPI:1457985095
Name:VALENZUELA, TARA (PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:
Last Name:VALENZUELA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 4TH ST N STE 300
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-4399
Mailing Address - Country:US
Mailing Address - Phone:843-474-5578
Mailing Address - Fax:843-790-1871
Practice Address - Street 1:2309 NORIEGA ST STE 888
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-4239
Practice Address - Country:US
Practice Address - Phone:843-474-5578
Practice Address - Fax:843-790-1871
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-22
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK165467363LP0808X
HIAPRN-3032363LP0808X
OR202101780NP-PP363LP0808X
CA95014026363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health