Provider Demographics
NPI:1932563202
Name:MENDEZ, TERESA E (APRN)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:E
Last Name:MENDEZ
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 1:1900 DON WICKHAM DR STE 110
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-1980
Mailing Address - Country:US
Mailing Address - Phone:352-241-7275
Mailing Address - Fax:352-241-7281
Practice Address - Street 1:601 E DIXIE AVE STE 401
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5997
Practice Address - Country:US
Practice Address - Phone:407-485-5711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9266247363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9266247OtherMEDICAL LICENSE
FL017344900Medicaid
FLARNP9266247OtherMEDICAL LICENSE