Healthcare Provider Details

I. General information

NPI: 1477473452
Provider Name (Legal Business Name): CAITLYN TEANEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4810 16TH AVE N
SAINT PETERSBURG FL
33713-4506
US

IV. Provider business mailing address

4810 16TH AVE N
SAINT PETERSBURG FL
33713-4506
US

V. Phone/Fax

Practice location:
  • Phone: 727-641-0365
  • Fax:
Mailing address:
  • Phone: 727-641-0365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11049172
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: