Healthcare Provider Details

I. General information

NPI: 1902368517
Provider Name (Legal Business Name): JESSICA MICHELLE TEPLICEK ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12216 PANAMA CITY BEACH PKWY STE B
PANAMA CITY BEACH FL
32407-2728
US

IV. Provider business mailing address

900 S PINE ISLAND RD STE 800
PLANTATION FL
33324-3923
US

V. Phone/Fax

Practice location:
  • Phone: 850-236-0488
  • Fax:
Mailing address:
  • Phone: 850-236-0488
  • Fax: 850-249-0971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP110010019
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN11001019
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: