Individual
AILISSA TEKLA RETALIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
110 POND CT STE 201, DEBARY, FL 32713-2717
(386) 317-8635
Mailing address
1826 WHIPPOORWILL LN, DELAND, FL 32720-2103
(386) 490-7537
(386) 490-7537
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
11040778
FL
Other
Enumeration date
07/09/2025
Last updated
12/09/2025
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