Provider Demographics
NPI:1689644593
Name:LUPTON, TERESA SUSAN (ARNP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:SUSAN
Last Name:LUPTON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 BARONSCOURT DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-3929
Mailing Address - Country:US
Mailing Address - Phone:863-221-3070
Mailing Address - Fax:813-779-3322
Practice Address - Street 1:22089 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-2364
Practice Address - Country:US
Practice Address - Phone:727-287-2784
Practice Address - Fax:727-669-9260
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3395092363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305923500Medicaid
FLY053WOtherBCBS
FLY053WOtherBCBS
FL305923500Medicaid