Provider Demographics
NPI:1578538799
Name:BUKAWESKI, TERESA A (RN)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:A
Last Name:BUKAWESKI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9800 S HEALTHPARK DR
Mailing Address - Street 2:#410
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-7603
Mailing Address - Country:US
Mailing Address - Phone:239-433-6760
Mailing Address - Fax:239-433-6766
Practice Address - Street 1:9800 S HEALTHPARK DR
Practice Address - Street 2:#410
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-7603
Practice Address - Country:US
Practice Address - Phone:239-433-6760
Practice Address - Fax:239-433-6766
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN3225272163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management