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NPI Code Detail

MEDICARE: TERESA B BRAVO M.D.

MEDICARE:   TERESA B BRAVO  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician043928CT
2207Q00000XFamily Medicine PhysicianME124549FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1STATE LICENSEOTHERCT043928
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3124549OTHERFLSTATE LICENSE
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093797854
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERESA B BRAVO M.D.
Provider Business Mailing Address
First Line : 904B CYPRESS PKWY
Second Line :
City : KISSIMMEE
State : FL
Zip : 34759-3456
Country : US
Telephone Number : 786-697-3549
Fax Number : 865-381-1572
Provider Business Practice Location Address
First Line : 904B CYPRESS PKWY
Second Line :
City : KISSIMMEE
State : FL
Zip : 34759-3456
Country : US
Telephone Number : 407-483-1400
Fax Number : 407-483-1405
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2005
Last Update Date : 10/16/2025

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Directions to “ TERESA B BRAVO M.D.” Practice Location

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