Individual
DALISSA MARIE TEJERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1475 NW 12TH AVE, MIAMI, FL 33136-1002
(305) 243-9136
Mailing address
1475 NW 12TH AVE, MIAMI, FL 33136-1002
(305) 243-9136
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
ARNP9288695
FL
363LA2200X
Adult Health Nurse Practitioner
9288695
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4668245
AETNA
FL
01
—
P1008781
FREEDOM HEALTH
FL
01
—
P948501
OPTIMUM
FL
01
—
QMP000003701324
MOLINA HEALTHCARE
FL
01
—
Y0J0D
BCBS OF FL
FL
Enumeration date
05/06/2013
Last updated
04/12/2016
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