Basic Information
| Provider Information | |||||||||
| NPI: | 1932563202 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MENDEZ | ||||||||
| FirstName: | TERESA | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 DON WICKHAM DR STE 110 | ||||||||
| Address2: | |||||||||
| City: | CLERMONT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347111980 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522417275 | ||||||||
| FaxNumber: | 3522417281 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 DON WICKHAM DR STE 110 | ||||||||
| Address2: | |||||||||
| City: | CLERMONT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347111980 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522417275 | ||||||||
| FaxNumber: | 3522417281 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2016 | ||||||||
| LastUpdateDate: | 05/20/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LX0001X | APRN9266247 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | ARNP9266247 | 01 | FL | MEDICAL LICENSE | OTHER | 017344900 | 05 | FL | MEDICAID |