Healthcare Provider Details

I. General information

NPI: 1295822864
Provider Name (Legal Business Name): TERESITA DE JESUS FELPETO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 02/24/2022
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9060 SW 73RD CT
PINECREST FL
33156-2961
US

IV. Provider business mailing address

9060 SW 73RD CT
PINECREST FL
33156-2961
US

V. Phone/Fax

Practice location:
  • Phone: 305-670-1111
  • Fax: 350-670-1110
Mailing address:
  • Phone: 305-670-1111
  • Fax: 350-670-1110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9101516
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: