Provider Demographics
NPI:1548516594
Name:VALENTINE, AMANDA (CPNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 SW GATLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-2757
Mailing Address - Country:US
Mailing Address - Phone:772-872-7114
Mailing Address - Fax:728-737-1157
Practice Address - Street 1:1721 SW GATLIN BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-2757
Practice Address - Country:US
Practice Address - Phone:772-873-7114
Practice Address - Fax:772-873-7115
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC199041163W00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1548516594Medicaid