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General NPI Number Information
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NPI Number | 1093797854
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Entity Type | Individual
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Provider Name | TERESA B BRAVO M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/17/2005
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 904B CYPRESS PKWY
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City | KISSIMMEE
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State | FL
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Zip | 34759-3456
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Country | US
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Telephone | 407-483-1400
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Fax | 407-483-1405
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Provider Business Mailing Address
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Address Line | 904B CYPRESS PKWY
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City | KISSIMMEE
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State | FL
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Zip | 34759-3456
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Country | US
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Telephone | 786-697-3549
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Fax | 865-381-1572
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 043928
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME124549
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License Number State | FL
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