Healthcare Provider Details

I. General information

NPI: 1215748702
Provider Name (Legal Business Name): ROSALEE PEREZ-TEEL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3574 US 1 S
ST AUGUSTINE FL
32086-6466
US

IV. Provider business mailing address

PO BOX 758
HOLLISTER FL
32147-0758
US

V. Phone/Fax

Practice location:
  • Phone: 904-417-7100
  • Fax: 904-824-0724
Mailing address:
  • Phone: 386-546-3190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11039726
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9561959
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: