Healthcare Provider Details

I. General information

NPI: 1528974805
Provider Name (Legal Business Name): TERESA PEREZ CARGIVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 STATE ROAD 37 S
MULBERRY FL
33860-8957
US

IV. Provider business mailing address

1805 STATE ROAD 37 S
MULBERRY FL
33860-8957
US

V. Phone/Fax

Practice location:
  • Phone: 863-614-4685
  • Fax:
Mailing address:
  • Phone: 863-614-4685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number311ZA0620X
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: