Healthcare Provider Details

I. General information

NPI: 1982716353
Provider Name (Legal Business Name): THERESA A BIEMER P.A-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 SW SAINT LUCIE WEST BLVD STE 106
PORT ST LUCIE FL
34986-1709
US

IV. Provider business mailing address

1420 SW SAINT LUCIE WEST BLVD STE 106
PORT ST LUCIE FL
34986-1709
US

V. Phone/Fax

Practice location:
  • Phone: 888-769-5408
  • Fax: 772-324-6440
Mailing address:
  • Phone: 888-769-5408
  • Fax: 772-324-6440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberPA9101894
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberPA9101894
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9101894
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: