Healthcare Provider Details

I. General information

NPI: 1013023936
Provider Name (Legal Business Name): TERESA A KOWALCZYK-VITOUS DNP.ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10155 OKEECHOBEE BLVD
WEST PALM BEACH FL
33411-1404
US

IV. Provider business mailing address

15097 93RD ST N
WEST PALM BEACH FL
33412-1798
US

V. Phone/Fax

Practice location:
  • Phone: 561-204-2349
  • Fax:
Mailing address:
  • Phone: 561-714-7432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3077902
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: