MEDICARE: TESS LINS APRN

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
1	363LF0000X	Family Nurse Practitioner	11007936	FL
2	207N00000X	Dermatology Physician	11007936	FL

General Provider Information

NPI Number	:	1104434745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TESS LINS APRN

Provider Business Mailing Address
First Line	:	11123 GREAT NECK RD
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33578-4686
Country	:	US
Telephone Number	:	321-243-9513
Fax Number	:

Provider Business Practice Location Address
First Line	:	957 E DEL WEBB BLVD STE 101
Second Line	:
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-6671
Country	:	US
Telephone Number	:	813-634-1484
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2020
Last Update Date	:	11/12/2021

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Directions to “ TESS LINS APRN” Practice Location

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