=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639788870
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GLORIA TERESA MEJIA APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2020
-----------------------------------------------------
Last Update Date | 05/05/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 36763 EILAND BLVD STE 201
-----------------------------------------------------
City | ZEPHYRHILLS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33542-0600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-977-8866
-----------------------------------------------------
Fax | 813-355-5060
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 38135 MARKET SQ
-----------------------------------------------------
City | ZEPHYRHILLS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33542-7505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-567-0188
-----------------------------------------------------
Fax | 813-355-5101
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | APRN11007097
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------