Provider Demographics
NPI:1295822864
Name:FELPETO, TERESITA DE JESUS
Entity Type:Individual
Prefix:
First Name:TERESITA DE JESUS
Middle Name:
Last Name:FELPETO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9060 SW 73RD CT
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2961
Mailing Address - Country:US
Mailing Address - Phone:305-670-1111
Mailing Address - Fax:350-670-1110
Practice Address - Street 1:9060 SW 73RD CT
Practice Address - Street 2:
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-2961
Practice Address - Country:US
Practice Address - Phone:305-670-1111
Practice Address - Fax:350-670-1110
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101516363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA 9101516OtherPHYSICIAN ASSISTANT