Provider Demographics
NPI:1255845392
Name:PERRY, THERESA KATHERINE (APRN)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:KATHERINE
Last Name:PERRY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 S PALAFOX ST UNIT 300
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32502-5905
Mailing Address - Country:US
Mailing Address - Phone:850-433-1656
Mailing Address - Fax:850-433-1996
Practice Address - Street 1:890 S PALAFOX ST UNIT 300
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-5905
Practice Address - Country:US
Practice Address - Phone:850-433-1656
Practice Address - Fax:850-433-1996
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23492363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health