Provider Demographics
NPI:1609546563
Name:TELAKAI HEALTH PA
Entity Type:Organization
Organization Name:TELAKAI HEALTH PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOERSCHEL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:951-821-8828
Mailing Address - Street 1:411 WALNUT ST UNIT 9659
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-3443
Mailing Address - Country:US
Mailing Address - Phone:951-821-8828
Mailing Address - Fax:
Practice Address - Street 1:411 WALNUT ST
Practice Address - Street 2:UNIT 9659
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043-3443
Practice Address - Country:US
Practice Address - Phone:951-821-8828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty