1245743053 NPI number — THERESA LYNN FERRETER MSN ARNP FNP BC

Table of content: THERESA LYNN FERRETER MSN ARNP FNP BC (NPI 1245743053)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245743053 NPI number — THERESA LYNN FERRETER MSN ARNP FNP BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERRETER
Provider First Name:
THERESA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN ARNP FNP BC
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:
1245743053
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5016 BRIGHTMOUR CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32837-4927
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-826-0298
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
988 E OSCEOLA PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KISSIMMEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34744-1615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-483-4079
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/15/2017

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: 363LF0000X , with the licence number:  2553982 , 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)





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