Provider Demographics
NPI:1508181686
Name:PERRAULT, TERESA (APRN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:PERRAULT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 WOODWARD ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-4256
Mailing Address - Country:US
Mailing Address - Phone:407-894-6980
Mailing Address - Fax:407-767-7644
Practice Address - Street 1:1836 WOODWARD ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4256
Practice Address - Country:US
Practice Address - Phone:407-894-6980
Practice Address - Fax:407-894-6982
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2641082363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics