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General NPI Number Information
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NPI Number | 1720420631
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Entity Type | Individual
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Provider Name | KRISTEN MARIE TEEL PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/19/2013
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Last Update Date | 02/01/2022
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Provider Practice Location Address
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Address Line | 17270 SE 109TH TERRACE RD
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City | SUMMERFIELD
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State | FL
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Zip | 34491-9015
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Country | US
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Telephone | 352-633-7222
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 830674
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City | BIRMINGHAM
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State | AL
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Zip | 35283-0674
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Country | US
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Telephone |
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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 | PA9107297
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9107297
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License Number State | FL
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