Provider Demographics
NPI:1982716353
Name:BIEMER, THERESA A (PA-C)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:A
Last Name:BIEMER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 SW SAINT LUCIE WEST BLVD
Mailing Address - Street 2:STE 106
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1709
Mailing Address - Country:US
Mailing Address - Phone:888-769-5408
Mailing Address - Fax:772-324-6440
Practice Address - Street 1:1420 SW SAINT LUCIE WEST BLVD STE 106
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1709
Practice Address - Country:US
Practice Address - Phone:888-769-5408
Practice Address - Fax:772-324-6440
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101894207QA0401X, 2084A0401X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P62437OtherMEDICARE UPIN
FLVAUPPOtherBCBS PROVIDER NUMBER
12697304OtherCAQH
FLP62437Medicare UPIN