Provider Demographics
NPI:1700862844
Name:WARNER, TERESE MARY (CRNA)
Entity Type:Individual
Prefix:MS
First Name:TERESE
Middle Name:MARY
Last Name:WARNER
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 1:1590 CENTURY ACRES LANE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259
Mailing Address - Country:US
Mailing Address - Phone:904-710-6811
Mailing Address - Fax:
Practice Address - Street 1:1590 CENTURY ACRES LANE
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259
Practice Address - Country:US
Practice Address - Phone:904-710-6811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX543487367500000X
FL9262060367500000X
WI123895367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003138340BMedicaid
FL009897800Medicaid
FL009897800Medicaid