Provider Demographics
NPI:1376179713
Name:BEM, TETIANA
Entity type:Individual
Prefix:
First Name:TETIANA
Middle Name:
Last Name:BEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9108 SUN TERRACE CIR APT C
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33403-4104
Mailing Address - Country:US
Mailing Address - Phone:561-502-4402
Mailing Address - Fax:
Practice Address - Street 1:500 UNIVERSITY BLVD STE 211
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2775
Practice Address - Country:US
Practice Address - Phone:561-323-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11006634363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily