Healthcare Provider Details

I. General information

NPI: 1669399242
Provider Name (Legal Business Name): TEDAZIA VINDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

726 RUE LABEAU CIR
FORT MYERS FL
33913-7508
US

IV. Provider business mailing address

6308 PANTHER LN
FORT MYERS FL
33919-5307
US

V. Phone/Fax

Practice location:
  • Phone: 239-826-7424
  • Fax:
Mailing address:
  • Phone: 239-826-7424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number800458675148
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: