Provider Demographics
NPI:1619129178
Name:VINCENT, THERESA ANN (NP)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:ANN
Last Name:VINCENT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:THERESA
Other - Middle Name:ANN
Other - Last Name:ARMIJO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:18126 MUIR WOODS CT
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5937
Mailing Address - Country:US
Mailing Address - Phone:714-594-3887
Mailing Address - Fax:714-534-3887
Practice Address - Street 1:18126 MUIR WOODS CT
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-5937
Practice Address - Country:US
Practice Address - Phone:714-594-3887
Practice Address - Fax:714-534-3887
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7763363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health