Provider Demographics
NPI:1326461914
Name:RENFROE, TERESA (DOM, AP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:RENFROE
Suffix:
Gender:F
Credentials:DOM, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4540 W KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2042
Mailing Address - Country:US
Mailing Address - Phone:813-289-6114
Mailing Address - Fax:813-200-9597
Practice Address - Street 1:4540 W KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2042
Practice Address - Country:US
Practice Address - Phone:813-289-6114
Practice Address - Fax:813-200-9597
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-02
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3367171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist