1376548859 NPI number — THERESA TOLLE RPH

Table of content: THERESA TOLLE RPH (NPI 1376548859)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376548859 NPI number — THERESA TOLLE RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOLLE
Provider First Name:
THERESA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376548859
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5797 TREASURE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRANT
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32949-8203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-733-6508
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7746 BAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEBASTIAN
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32958-3427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-589-2043
Provider Business Practice Location Address Fax Number:
772-388-2628
Provider Enumeration Date:
06/20/2005

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: 183500000X , with the licence number:  FL24449 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com