Provider Demographics
NPI:1659327732
Name:KINSEY, TERESA A (CRNA)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:A
Last Name:KINSEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:956 NW EGRET CT
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-9532
Mailing Address - Country:US
Mailing Address - Phone:772-692-9806
Mailing Address - Fax:772-692-1861
Practice Address - Street 1:1874 SE PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5545
Practice Address - Country:US
Practice Address - Phone:772-336-7676
Practice Address - Fax:772-668-9034
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1801932367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308695000Medicaid
FLP00807037OtherRAILROAD MEDICARE
FLG1880YOtherMEDICARE-MFAA
FLG3830OtherBCBS OF FLORIDA
FLG1880ZMedicare PIN