Provider Demographics
NPI:1164288858
Name:SILVEREST, THRESA (AGACNP)
Entity Type:Individual
Prefix:
First Name:THRESA
Middle Name:
Last Name:SILVEREST
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 CULTURAL PARK BLVD APT A
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-1273
Mailing Address - Country:US
Mailing Address - Phone:863-221-5497
Mailing Address - Fax:
Practice Address - Street 1:7981 GLADIOLUS DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4154
Practice Address - Country:US
Practice Address - Phone:239-939-0999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9511960363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care