Provider Demographics
NPI:1164408233
Name:DRYDEN, THERESA W (ANP-C)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:W
Last Name:DRYDEN
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:MRS
Other - First Name:THERESA
Other - Middle Name:W
Other - Last Name:HARDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP-C
Mailing Address - Street 1:1434 KENNEDY DR UNIT 1
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4008
Mailing Address - Country:US
Mailing Address - Phone:305-395-7677
Mailing Address - Fax:305-395-7913
Practice Address - Street 1:1434 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4008
Practice Address - Country:US
Practice Address - Phone:305-395-7677
Practice Address - Fax:305-395-7913
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11001549363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0241Medicaid
SCAA67715551Medicare PIN
SCAA1678Medicare PIN
SC4744Medicare PIN
SCNP0241Medicaid