1780309500 NPI number — MRS. NANCY LEE ANNE TELATYCKI MSW

Table of content: (NPI 1346138674)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780309500 NPI number — MRS. NANCY LEE ANNE TELATYCKI MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TELATYCKI
Provider First Name:
NANCY
Provider Middle Name:
LEE ANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ELSWICK
Provider Other First Name:
NANCY
Provider Other Middle Name:
LEE ANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780309500
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11269 SALOME ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKSVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34614-3424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-942-5966
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13515 LAKE TERRACE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33637-1003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-998-8000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/04/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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