Provider Demographics
NPI:1083355911
Name:ENGLUTT, THERESA DANIELLE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:DANIELLE
Last Name:ENGLUTT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:1513 RIDGEWAY DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-3211
Mailing Address - Country:US
Mailing Address - Phone:903-436-6444
Mailing Address - Fax:
Practice Address - Street 1:5012 S US HIGHWAY 75 STE 200
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-4610
Practice Address - Country:US
Practice Address - Phone:903-465-5012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1066568363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner