Provider Demographics
NPI:1952735441
Name:BRUGGEMAN, TERESA MARIE (AP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:BRUGGEMAN
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1634 NW 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4078
Mailing Address - Country:US
Mailing Address - Phone:717-424-0843
Mailing Address - Fax:
Practice Address - Street 1:1240 NW 11TH AVE
Practice Address - Street 2:SUITE E
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-4146
Practice Address - Country:US
Practice Address - Phone:717-424-0843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 3203171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist