Provider Demographics
NPI:1013023936
Name:KOWALCZYK-VITOUS, TERESA A (DNPARNP)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:A
Last Name:KOWALCZYK-VITOUS
Suffix:
Gender:F
Credentials:DNPARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15097 93RD ST N
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33412-1798
Mailing Address - Country:US
Mailing Address - Phone:561-714-7432
Mailing Address - Fax:
Practice Address - Street 1:10155 OKEECHOBEE BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-1404
Practice Address - Country:US
Practice Address - Phone:561-204-2349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3077902363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP92913Medicare UPIN