Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | 11015909 | FL |
N | 363LA2200X | Nurse Practitioner - Adult Health | 11015909 | FL |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 11015909 | FL |
N | 363LC1500X | Nurse Practitioner - Community Health | 11015909 | FL |
N | 363LG0600X | Nurse Practitioner - Gerontology | 11015909 | FL |
NPI | 1447915699 |
---|---|
Provider Name | Jennifer Corona Teitelbaum |
First Address | Port St Lucie, FL 34984-8939 |
Second Address | Port St Lucie, FL 34984-8939 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2021 |
Last Update Date | 03/11/2021 |