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NPI Code Detail

MEDICARE: INGRID TELASCO-MAURISSEAU ARNP

MEDICARE: INGRID TELASCO-MAURISSEAU ARNP
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner9211750FL
2363LF0000XFamily Nurse Practitioner9211750FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508223256
Entity Type Code : Individual
Provider Name (Legal Business Name) : INGRID TELASCO-MAURISSEAU ARNP
Provider Business Mailing Address
First Line : 200 OCEANGATE
Second Line : STE 100
City : LONG BEACH
State : CA
Zip : 90802-4317
Country : US
Telephone Number : 888-562-5442
Fax Number : 844-861-1929
Provider Business Practice Location Address
First Line : 6766 FOREST HILL BLVD
Second Line :
City : GREENACRES
State : FL
Zip : 33413-3321
Country : US
Telephone Number : 561-966-0015
Fax Number : 888-875-1781
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2016
Last Update Date : 02/12/2026

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