Healthcare Provider Details

I. General information

NPI: 1831893650
Provider Name (Legal Business Name): OLIVIA TENG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11555 CENTRAL PKWY STE 903
JACKSONVILLE FL
32224-2701
US

IV. Provider business mailing address

11555 CENTRAL PKWY STE 903 SUITE 903
JACKSONVILLE FL
32224-2701
US

V. Phone/Fax

Practice location:
  • Phone: 863-874-0898
  • Fax:
Mailing address:
  • Phone: 863-874-0898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME170275
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: