Healthcare Provider Details

I. General information

NPI: 1205647161
Provider Name (Legal Business Name): HEATHER RENEE TEEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2025
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 FOWLER GROVE BLVD STE 300
WINTER GARDEN FL
34787
US

IV. Provider business mailing address

2200 FOWLER GROVE BLVD STE 300
WINTER GARDEN FL
34787
US

V. Phone/Fax

Practice location:
  • Phone: 407-347-0751
  • Fax: 407-347-0752
Mailing address:
  • Phone: 407-347-0751
  • Fax: 407-347-0752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11037226
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: