Provider Demographics
NPI:1649866468
Name:TANAEL, IMEE VALERIE SELOM (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:IMEE VALERIE
Middle Name:SELOM
Last Name:TANAEL
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3818 W NORTH A ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2703
Mailing Address - Country:US
Mailing Address - Phone:949-705-9441
Mailing Address - Fax:
Practice Address - Street 1:3010 E 138TH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3904
Practice Address - Country:US
Practice Address - Phone:813-975-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11010592363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily