Healthcare Provider Details

I. General information

NPI: 1538158795
Provider Name (Legal Business Name): TERESA MICHELLE DESERT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37814 MEDICAL ARTS CT
ZEPHYRHILLS FL
33541-4325
US

IV. Provider business mailing address

29532 DARBY RD.
DADE CITY FL
33525
US

V. Phone/Fax

Practice location:
  • Phone: 813-780-2550
  • Fax: 813-780-1450
Mailing address:
  • Phone: 352-588-2099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN9174700
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: