Provider Demographics
NPI:1871880732
Name:VELEZ, TERESA K (ARNP)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:K
Last Name:VELEZ
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 1:42 SEATON VALLEY PATH
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-5365
Mailing Address - Country:US
Mailing Address - Phone:386-453-7268
Mailing Address - Fax:
Practice Address - Street 1:42 SEATON VALLEY PATH
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-5365
Practice Address - Country:US
Practice Address - Phone:386-453-7268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2015-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9226068363LF0000X, 163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004380200Medicaid
FLHQ036AMedicare PIN