Healthcare Provider Details

I. General information

NPI: 1760973861
Provider Name (Legal Business Name): MARIA ROSELYN TECSON CALUNGCAGUIN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 PRESCOTT LOOP
LAKELAND FL
33810-2863
US

IV. Provider business mailing address

3611 PRESCOTT LOOP
LAKELAND FL
33810-2863
US

V. Phone/Fax

Practice location:
  • Phone: 786-342-5144
  • Fax:
Mailing address:
  • Phone: 786-342-5144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number9252304
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number9252304
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number9252304
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: