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General NPI Number Information
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NPI Number | 1093477895
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Entity Type | Individual
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Provider Name | TRESA BIETOLA FNP
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Gender | Female
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Dates
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Enumeration Date | 10/08/2021
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Last Update Date | 10/08/2021
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Provider Practice Location Address
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Address Line | 2450 HOLLYWOOD BLVD STE 701
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City | HOLLYWOOD
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State | FL
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Zip | 33020-6628
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Country | US
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Telephone | 954-367-5316
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Fax |
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Provider Business Mailing Address
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Address Line | 3562 SOUTHERN ORCHARD RD W
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City | DAVIE
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State | FL
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Zip | 33328-6900
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Country | US
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Telephone | 519-980-7667
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11015567
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License Number State | FL
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