Provider Demographics
NPI:1174165914
Name:MOCK, VALERIE NICOLE (PA-C)
Entity type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:NICOLE
Last Name:MOCK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 EVERNIA ST APT 1817
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-5787
Mailing Address - Country:US
Mailing Address - Phone:612-227-2050
Mailing Address - Fax:
Practice Address - Street 1:638 E ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-5326
Practice Address - Country:US
Practice Address - Phone:561-409-5959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9113405208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery