Provider Demographics
NPI:1477628063
Name:CUEVAS, THERESA L (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:L
Last Name:CUEVAS
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3322 W END AVE
Mailing Address - Street 2:11TH FLOOR
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1031
Mailing Address - Country:US
Mailing Address - Phone:615-515-9880
Mailing Address - Fax:
Practice Address - Street 1:1100 BROAD AVENUE
Practice Address - Street 2:SUITE 600
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501
Practice Address - Country:US
Practice Address - Phone:228-284-1634
Practice Address - Fax:228-284-1635
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR850390363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00124120Medicaid
MS25-3486-500000967Medicare ID - Type Unspecified
MS00124120Medicaid