Healthcare Provider Details

I. General information

NPI: 1245004472
Provider Name (Legal Business Name): TELE-ME ABOUT IT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2861 EMERSON DR SE
PALM BAY FL
32909-5254
US

IV. Provider business mailing address

3425 BAYSIDE LAKES BLVD SE STE 103
PALM BAY FL
32909-6867
US

V. Phone/Fax

Practice location:
  • Phone: 321-557-3065
  • Fax:
Mailing address:
  • Phone: 321-557-3065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. DOMINIQUE GORDON
Title or Position: OWNER/PROVIDER
Credential: FNP-C, PMHNP-BC
Phone: 321-557-3065