Healthcare Provider Details

I. General information

NPI: 1073860383
Provider Name (Legal Business Name): THERESA BANDORF WINTON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2012
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 M D LN STE A
TALLAHASSEE FL
32308-5349
US

IV. Provider business mailing address

2606 CENTENNIAL PL
TALLAHASSEE FL
32308-0572
US

V. Phone/Fax

Practice location:
  • Phone: 508-770-6358
  • Fax: 850-205-0195
Mailing address:
  • Phone: 850-205-0189
  • Fax: 850-329-2903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP3076922
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: