Provider Demographics
NPI:1578223731
Name:RODELA, TERESA (RN)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:
Last Name:RODELA
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 1:345 COLONIAL BLF
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-3005
Mailing Address - Country:US
Mailing Address - Phone:939-216-3905
Mailing Address - Fax:770-723-8803
Practice Address - Street 1:1391 NW 136TH AVE
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-2800
Practice Address - Country:US
Practice Address - Phone:939-216-3905
Practice Address - Fax:770-723-8803
Is Sole Proprietor?:No
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX609944163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management