MEDICARE: TERESA LYNN WHITE LMT, LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA66517	FL
2	164W00000X	Licensed Practical Nurse	PN5253572	FL

General Provider Information

NPI Number	:	1336929918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA LYNN WHITE LMT, LPN

Provider Business Mailing Address
First Line	:	3200 HOLIDAY SPRINGS BLVD APT 203
Second Line	:
City	:	MARGATE
State	:	FL
Zip	:	33063-5478
Country	:	US
Telephone Number	:	954-317-1700
Fax Number	:

Provider Business Practice Location Address
First Line	:	7504 WILES RD STE A104
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-2031
Country	:	US
Telephone Number	:	954-317-1700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2023
Last Update Date	:	10/02/2023

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