Healthcare Provider Details

I. General information

NPI: 1023954112
Provider Name (Legal Business Name): CAROLYNE TEIXEIRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16102 N FLORIDA AVE
LUTZ FL
33549-6129
US

IV. Provider business mailing address

1250 E MADISON ST UNIT 305
TAMPA FL
33602-4043
US

V. Phone/Fax

Practice location:
  • Phone: 973-583-3817
  • Fax:
Mailing address:
  • Phone: 973-583-3817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number27046
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: