Provider Demographics
NPI:1033412549
Name:NARASIMHAN, THERESA ANNE (RN, MSN)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:ANNE
Last Name:NARASIMHAN
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:MS
Other - First Name:THERESA
Other - Middle Name:ANNE
Other - Last Name:KONEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1431 RIVERPLACE BLVD
Mailing Address - Street 2:UNIT 3408
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-9028
Mailing Address - Country:US
Mailing Address - Phone:414-336-4399
Mailing Address - Fax:
Practice Address - Street 1:1431 RIVERPLACE BLVD
Practice Address - Street 2:UNIT 3408
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-9028
Practice Address - Country:US
Practice Address - Phone:414-336-4399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.008804363LA2200X
FL9360704363LA2200X
NYF306932-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health