Provider Demographics
NPI:1285654954
Name:OBERBROECKLING, TERESA ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:ANN
Last Name:OBERBROECKLING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:ANN
Other - Last Name:KESLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:300 S HYDE PARK AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-4125
Mailing Address - Country:US
Mailing Address - Phone:937-609-1798
Mailing Address - Fax:813-402-2956
Practice Address - Street 1:300 S HYDE PARK AVE STE 210
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-4125
Practice Address - Country:US
Practice Address - Phone:937-609-1798
Practice Address - Fax:813-402-2956
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105405363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant