Provider Demographics
NPI:1093735805
Name:OAKLEY, THERESA MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:MARIE
Last Name:OAKLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-4235
Mailing Address - Country:US
Mailing Address - Phone:407-889-9800
Mailing Address - Fax:407-889-8910
Practice Address - Street 1:63 E 3RD ST
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-4235
Practice Address - Country:US
Practice Address - Phone:407-889-9800
Practice Address - Fax:407-889-8910
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8194208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265258700Medicaid
FLH70244Medicare UPIN
K3814Medicare UPIN