MEDICARE: TEGAN BISSELL RD, LDN, CDCES

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	133V00000X	Registered Dietitian	ND6894	FL

General Provider Information

NPI Number	:	1437542230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEGAN BISSELL RD, LDN, CDCES

Provider Business Mailing Address
First Line	:	407 COCONUT AVE E
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-1328
Country	:	US
Telephone Number	:	802-376-8964
Fax Number	:

Provider Business Practice Location Address
First Line	:	3496 NW FEDERAL HWY
Second Line	:	SUITE F
City	:	JENSEN BEACH
State	:	FL
Zip	:	34957-4441
Country	:	US
Telephone Number	:	772-223-4916
Fax Number	:	772-223-2887

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

Provider Enumeration Date	:	03/18/2015
Last Update Date	:	03/07/2026

Similar Medicare Providers

1811989049 — MRS. JENNIFER A RECTOR ARNP
Practice Location Address:

3496 NW FEDERAL HWY STE A
JENSEN BEACH, FL
34957-4441

Practice Phone: 772-223-5612
Practice Fax: 772-223-5654

1124003207 — DR. DOUGLAS W BOWLING M.D.
Practice Location Address:

3496 NW FEDERAL HWY
JENSEN BEACH, FL
34957-4441

Practice Phone: 772-223-5612
Practice Fax: 772-223-4949

1750366878 — DR. YVETTE CLAIRE BUSHEY D.O.
Practice Location Address:

3496 NW FEDERAL HWY
JENSEN BEACH, FL
34957-4441

Practice Phone: 772-223-5665
Practice Fax: 772-223-5646

1154391712 — DR. ROBERT MA D.D.S
Practice Location Address:

3476 NW FEDERAL HWY
JENSEN BEACH, FL
34957-4441

Practice Phone: 772-692-4002
Practice Fax:

1336105592 — DR. GINA LOU PENAFLOR MD
Practice Location Address:

3496 NW FEDERAL HWY
JENSEN BEACH, FL
34957-4441

Practice Phone: 772-223-5612
Practice Fax: 772-223-5689

1205865490 — ROBERT PARE JR. MD
Practice Location Address:

3498 NW FEDERAL HWY
JENSEN BEACH, FL
34957-4441

Practice Phone: 772-219-1080
Practice Fax: 772-219-1070

Directions to “ TEGAN BISSELL RD, LDN, CDCES” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.