Provider Demographics
NPI:1386260420
Name:TEIJEIRO, MADBEL (APRN)
Entity type:Individual
Prefix:
First Name:MADBEL
Middle Name:
Last Name:TEIJEIRO
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15720 BULL RUN RD APT 474
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2181
Mailing Address - Country:US
Mailing Address - Phone:786-626-5334
Mailing Address - Fax:
Practice Address - Street 1:13926 SW 47TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-4404
Practice Address - Country:US
Practice Address - Phone:305-340-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11007772363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily