Provider Demographics
NPI:1811436546
Name:TEJADA, VIELKA (ARNP)
Entity type:Individual
Prefix:
First Name:VIELKA
Middle Name:
Last Name:TEJADA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 MAUMEE STREET
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828
Mailing Address - Country:US
Mailing Address - Phone:407-417-2924
Mailing Address - Fax:407-207-8933
Practice Address - Street 1:670 N ORLANDO AVE STE 1003
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4467
Practice Address - Country:US
Practice Address - Phone:407-482-7788
Practice Address - Fax:407-207-8933
Is Sole Proprietor?:No
Enumeration Date:2017-02-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9291457363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP 9291457OtherSTATE OF FLORIDA