Provider Demographics
NPI:1801575345
Name:VALDIVIA, DANIEL OMAR (APRN)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:OMAR
Last Name:VALDIVIA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13551 LUXE AVE APT 106
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-4507
Mailing Address - Country:US
Mailing Address - Phone:941-920-6646
Mailing Address - Fax:
Practice Address - Street 1:13551 LUXE AVE APT 106
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-4507
Practice Address - Country:US
Practice Address - Phone:941-920-6646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL2023060082363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health