1477628063 NPI number — MRS. THERESA L CUEVAS C.F.N.P.

Table of content: MRS. THERESA L CUEVAS C.F.N.P. (NPI 1477628063)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477628063 NPI number — MRS. THERESA L CUEVAS C.F.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUEVAS
Provider First Name:
THERESA
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
C.F.N.P.
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:
1477628063
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3322 W END AVE
Provider Second Line Business Mailing Address:
11TH FLOOR
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37203-1031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-515-9880
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 BROAD AVENUE
Provider Second Line Business Practice Location Address:
SUITE 600
Provider Business Practice Location Address City Name:
GULFPORT
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-284-1634
Provider Business Practice Location Address Fax Number:
228-284-1635
Provider Enumeration Date:
11/21/2006

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:  R850390 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00124120 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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