Provider Demographics
NPI:1508989880
Name:RIZZO, THERESA MARIE (AP)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:RIZZO
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:
Other - Last Name:RIZZO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AP
Mailing Address - Street 1:617 NE 6TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-5569
Mailing Address - Country:US
Mailing Address - Phone:352-284-0817
Mailing Address - Fax:352-335-0554
Practice Address - Street 1:1330 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-2211
Practice Address - Country:US
Practice Address - Phone:352-284-0817
Practice Address - Fax:352-335-0554
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1674171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC0808OtherBLUE CROSS BLUE SHIELD