Provider Demographics
NPI:1871894162
Name:VALENTINE, SALISIA SHUNTA (NP)
Entity type:Individual
Prefix:
First Name:SALISIA
Middle Name:SHUNTA
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SALISIA
Other - Middle Name:SHUNTA
Other - Last Name:GAMBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:702 ALEXANDRIA RD
Mailing Address - Street 2:
Mailing Address - City:WEAVER
Mailing Address - State:AL
Mailing Address - Zip Code:36277-4318
Mailing Address - Country:US
Mailing Address - Phone:256-283-2917
Mailing Address - Fax:
Practice Address - Street 1:1505 PELHAM RD S
Practice Address - Street 2:SUITE 2
Practice Address - City:JACKSONVILLE
Practice Address - State:AL
Practice Address - Zip Code:36265-3706
Practice Address - Country:US
Practice Address - Phone:256-435-7300
Practice Address - Fax:256-435-7305
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-098772363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily