MEDICARE: TERESA TESHEA TEEL 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	363LG0600X	Gerontology Nurse Practitioner	APRN11025537	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1609570969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA TESHEA TEEL APRN

Provider Business Mailing Address
First Line	:	2744 GULF BREEZE PKWY
Second Line	:
City	:	GULF BREEZE
State	:	FL
Zip	:	32563-3091
Country	:	US
Telephone Number	:	850-934-5713
Fax Number	:	850-934-0379

Provider Business Practice Location Address
First Line	:	2744 GULF BREEZE PKWY
Second Line	:
City	:	GULF BREEZE
State	:	FL
Zip	:	32563-3091
Country	:	US
Telephone Number	:	850-934-5713
Fax Number	:	850-934-0379

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

Provider Enumeration Date	:	03/29/2023
Last Update Date	:	05/23/2024

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