Provider Demographics
NPI:1508348111
Name:HESS, THERESA LYNN (RN)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:LYNN
Last Name:HESS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3697 LAKE EMMA RD STE 126
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-6121
Mailing Address - Country:US
Mailing Address - Phone:407-506-2999
Mailing Address - Fax:
Practice Address - Street 1:3697 LAKE EMMA RD STE 126
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-6121
Practice Address - Country:US
Practice Address - Phone:407-506-2999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9271628163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health