Basic Information
| Provider Information | |||||||||
| NPI: | 1336238682 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TEAGARDEN | ||||||||
| FirstName: | DANA | ||||||||
| MiddleName: | DELORES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 770 NORTHPOINT PKWY STE 102 | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334071901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612757604 | ||||||||
| FaxNumber: | 5618025385 | ||||||||
| Practice Location | |||||||||
| Address1: | 770 NORTHPOINT PKWY STE 200 | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616553331 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 08/30/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | DO1550 | TN | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | OS15395 | FL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 4066101 | 01 | TN | TENNCARE PROVIDER | OTHER | 4066101 | 01 | TN | BLUE CROSS BLUE SHIELD | OTHER | 4283643 | 01 | TN | BLUE CROSS BLUE SHIELD OF TENNESSEE | OTHER |