Healthcare Provider Details

I. General information

NPI: 1124973581
Provider Name (Legal Business Name): GERARD TYLOR TEAMER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 JACKS RD
DAVENPORT FL
33897-8007
US

IV. Provider business mailing address

562 ROBIN HILL CIR
BRANDON FL
33510-3319
US

V. Phone/Fax

Practice location:
  • Phone: 863-340-1990
  • Fax:
Mailing address:
  • Phone: 813-894-8655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11050105
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: