Provider Demographics
NPI:1740565142
Name:THEODOSIS, PAULA LISA (RN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:LISA
Last Name:THEODOSIS
Suffix:
Gender:F
Credentials:RN, FNP-BC
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-215-9924
Mailing Address - Fax:
Practice Address - Street 1:2005 W WALLACE ST
Practice Address - Street 2:
Practice Address - City:SAN SABA
Practice Address - State:TX
Practice Address - Zip Code:76877-3928
Practice Address - Country:US
Practice Address - Phone:325-372-5163
Practice Address - Fax:325-372-3988
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX751797363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily