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General NPI Number Information
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NPI Number | 1609546563
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Entity Type | Organization
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Legal Business Name | TELAKAI HEALTH PA
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Dates
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Enumeration Date | 09/14/2021
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Last Update Date | 09/14/2021
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Provider Practice Location Address
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Address Line | 411 WALNUT ST UNIT 9659
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City | GREEN COVE SPRINGS
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State | FL
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Zip | 32043-3443
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Country | US
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Telephone | 951-821-8828
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Fax |
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Provider Business Mailing Address
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Address Line | 411 WALNUT ST UNIT 9659
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City | GREEN COVE SPRINGS
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State | FL
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Zip | 32043-3443
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Country | US
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Telephone | 951-821-8828
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALEXANDRA DOERSCHEL
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Credential | NP
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Telephone | 951-821-8828
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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 |
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License Number State |
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