Provider Demographics
NPI:1043663537
Name:TELLECHEA CASANUEVA, MILENA (ARNP)
Entity type:Individual
Prefix:
First Name:MILENA
Middle Name:
Last Name:TELLECHEA CASANUEVA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 SANTO DOMINGO AVE SW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32908-7427
Mailing Address - Country:US
Mailing Address - Phone:305-878-3037
Mailing Address - Fax:
Practice Address - Street 1:761 SANTO DOMINGO AVE SW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32908
Practice Address - Country:US
Practice Address - Phone:305-878-3037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9331120363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health