Healthcare Provider Details

I. General information

NPI: 1699482885
Provider Name (Legal Business Name): JULIE TEIGEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2022
Last Update Date: 10/28/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 SE GOLDTREE DR STE 107
PORT ST LUCIE FL
34952-7582
US

IV. Provider business mailing address

900 VILLAGE SQUARE XING STE 290
PALM BEACH GARDENS FL
33410-4552
US

V. Phone/Fax

Practice location:
  • Phone: 772-335-3550
  • Fax: 772-337-4113
Mailing address:
  • Phone: 239-232-1180
  • Fax: 239-666-9211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11020698
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: